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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Yang Z, Wang M, Li Z, Hu Y, Jiang J, Yu F, Zeng J, Chen W, Yang X. Repeatability and Reproducibility of Corneoscleral Topography Measured With Scheimpflug Imaging in Keratoconus and Control Eyes. Eye Contact Lens 2023; 49:234-240. [PMID: 36989487 DOI: 10.1097/icl.0000000000000983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To determine and compare the repeatability and reproducibility of anterior scleral parameters measured by the corneoscleral profile (CSP) module of Pentacam in keratoconus (KC) and control eyes. METHODS This is a prospective observational study. Thirty KC participants (30 eyes) and 24 control participants (24 eyes) were examined three times using the CSP. Sagittal height mean (SHM), sagittal height astigmatism (SHA), and mean bulbar slope (BSM) were measured in 12 mm and 16 mm chord lengths. The repeatability and reproducibility of these measurements were also assessed. Coefficients of variation (CoV), intraclass correlation coefficient (ICC), coefficient of repeatability (CoR1), and coefficient of reproducibility (CoR2) were adopted to assess the reliability. RESULTS In the KC and control groups, SHM showed high repeatability and reproducibility (coefficients of variation [CoVs]≤0.96%, intraclass correlation coefficient [ICCs]≥0.97), and SHM of control eyes showed higher repeatability and reproducibility than that of KC eyes at 12 mm chord length (KC group, CoRs ranged from 35.56 μm to 43.52 μm, control group, ranged from 23.50 μm to 30.31 μm) and 16 mm chord length (KC group, CoRs ranged from 79.54 μm to 81.58 μm, control group, ranged from 48.25 μm to 66.10 μm). Mean bulbar slope also showed high repeatability and reproducibility (CoVs≤3.65%, CoRs≤2.64). Furthermore, the SHA of control eyes showed higher repeatability and reproducibility when compared with KC eyes (control group: CoVs≤29.95%, KC group: CoVs≥32.67%). CONCLUSIONS Keratoconus and control eyes demonstrated high repeatability and reproducibility when using CSP measurements, which may prove helpful in fitting contact lenses.
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Affiliation(s)
- Zhengfei Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Bergmann B, Wolffsohn JS, Bandlitz S. Scheimpflug imaging for grading and measurement of corneo-scleral-profile in different quadrants. Cont Lens Anterior Eye 2023; 46:101753. [PMID: 36030150 DOI: 10.1016/j.clae.2022.101753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The corneo-scleral-profile (CSP) describes the transition from cornea to sclera, while the corneo-scleral junction angle (CSJ), is the angle formed between the cornea and the sclera. The aims of this study were (i) to analyse the CSP and CSJ in different quadrants and (ii) to test correlation and repeatability of an established observational grading and measurement method, using Scheimpflug images. METHODS The nasal, temporal, superior and inferior CSP of 35 healthy eye participants (mean age 25.5 SD ± 3.1 years; 20 female) was imaged using the corneo-scleral-profile module of the Pentacam (Oculus, Wetzlar, Germany). On the captured Scheimpflug images CSP was subjectively graded into five different corneo-scleral transitions, using the Meier grading scale (profile 1 fluid-convex; profile 2 fluid-tangential; profile 3 marked-convex; profile 4 marked-tangential; profile 5 concave). The CSJ was measured on the same images using ImageJ v1.8.0. Grading and measurement was repeated at a second session. Intra-observer reliability for the CSP-grading was analysed by Cohen's Kappa. Differences between repeated CSJ-measurements and different quadrants were analysed by paired-t-test and ANOVA. The eta-coefficient was used to determine the association between subjective CSP-grading and CSJ-measurement. RESULTS Intra-observer reliability for the CSP grading system was poor (kappa = 0.098) whereas repeated measurements of CSJ angle showed no statistically significant difference between sessions (0.04°; 95 % CI - 0.21° to 0.29°; p = 0.77). CSJ angles ranged from 172° to 180° with no statistically significant differences between nasal, temporal, superior and inferior (p = 0.24). Eta-coefficient indicated a weak association between CSP-grading and CSJ-measurement (η = 0.27; p = 0.04). CONCLUSIONS The subjective CSP-grading showed poorer repeatability than the objective CSJ-measurement, which did not detect any differences in angles between the meridians. The weak association between CSP-grading and CSJ-measurement is likely caused by the limited intra-observer reliability of the Meier grading scale. Furthermore, the CSP-grading scale seems to consider other aspects beside the CSJ angle, such as scleral radius.
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Affiliation(s)
- Benjamin Bergmann
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany
| | - James S Wolffsohn
- School of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Stefan Bandlitz
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany; School of Health and Life Sciences, Aston University, Birmingham, United Kingdom.
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Towler J, Consejo A, Zhou D, Romano V, Levis H, Boote C, Elsheikh A, Geraghty B, Abass A. Typical localised element-specific finite element anterior eye model. Heliyon 2023; 9:e13944. [PMID: 37101628 PMCID: PMC10123217 DOI: 10.1016/j.heliyon.2023.e13944] [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: 02/21/2022] [Revised: 11/19/2022] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
Purpose The study presents an averaged anterior eye geometry model combined with a localised material model that is straightforward, appropriate and amenable for implementation in finite element (FE) modelling. Methods Both right and left eye profile data of 118 subjects (63 females and 55 males) aged 22-67 years (38.5 ± 7.6) were used to build an averaged geometry model. Parametric representation of the averaged geometry model was achieved through two polynomials dividing the eye into three smoothly connected volumes. This study utilised the collagen microstructure x-ray data of 6 ex-vivo healthy human eyes, 3 right eyes and 3 left eyes in pairs from 3 donors, 1 male and 2 females aged between 60 and 80 years, to build a localised element-specific material model for the eye. Results Fitting the cornea and the posterior sclera sections to a 5th-order Zernike polynomial resulted in 21 coefficients. The averaged anterior eye geometry model recorded a limbus tangent angle of 37° at a radius of 6.6 mm from the corneal apex. In terms of material models, the difference between the stresses generated in the inflation simulation up to 15 mmHg in the ring-segmented material model and localised element-specific material model were significantly different (p < 0.001) with the ring-segmented material model recording average Von-Mises stress 0.0168 ± 0.0046 MPa and the localised element-specific material model recording average Von-Mises stress 0.0144 ± 0.0025 MPa. Conclusions The study illustrates an averaged geometry model of the anterior human eye that is easy to generate through two parametric equations. This model is combined with a localised material model that can be used either parametrically through a Zernike fitted polynomial or non-parametrically as a function of the azimuth angle and the elevation angle of the eye globe. Both averaged geometry and localised material models were built in a way that makes them easy to implement in FE analysis without additional computation cost compared to the limbal discontinuity so-called idealised eye geometry model or ring-segmented material model.
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Affiliation(s)
- Joseph Towler
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Dong Zhou
- Department of Civil Engineering and Industrial Design, School of Engineering, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Medical and Surgical Specialities, Radiological Sciences, And Public Health, Ophthalmology Clinic, University of Brescia, Italy
| | - Hannah Levis
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Craig Boote
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Ahmed Elsheikh
- Department of Civil Engineering and Industrial Design, School of Engineering, University of Liverpool, Liverpool, UK
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Brendan Geraghty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ahmed Abass
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, UK
- Department of Production Engineering and Mechanical Design, Faculty of Engineering, Port Said University, Egypt
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Bandlitz S, Lagodny M, Kurz C, Wolffsohn JS. Anterior ocular surface sagittal height prediction. Ophthalmic Physiol Opt 2022; 42:1023-1031. [PMID: 35703419 DOI: 10.1111/opo.13017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the validity of Placido-based corneal topography parameters to predict corneoscleral sagittal heights measured by Fourier-based profilometry at various diameters. METHODS Minimal (Minsag ), maximal (Maxsag ) sagittal height, toricity (Maxsag - Minsag ) and axis of the flattest meridian (Minsag ) of 36 subjects (mean age 25.4 SD ± 3.2 years; 21 female) were measured using the Eye Surface Profiler and analysed for diameters (chord length) of 8 to 16 mm (in 2-mm intervals). Furthermore, corneal central radii, corneal astigmatism, eccentricity and diameter were measured using the Keratograph 5 M. RESULTS Using multiple linear regression analysis, the best equation for predicting the sagittal heights for 8 mm (r2 = 0.95), and 10 mm (r2 = 0.93) diameters included corneal central radii and eccentricity. The best equation for predicting sagittal heights for 12 mm (r2 = 0.86), 14 mm (r2 = 0.78) and 16 mm (r2 = 0.65) diameters included corneal central radii, eccentricity and corneal diameter. Corneal astigmatism was significantly correlated with sagittal height toricity for 8 and 10 mm diameters (r2 = 0.50 and 0.29; p < 0.01), while no correlation was observed for 12, 14 and 16 mm diameters (p = 0.18 to p = 0.76). The axis of the flattest corneal meridian measured by Placido-based topography was significantly correlated with the axis of the flattest meridian measured by Fourier-based profilometry for 8, 10 and 12 mm diameters (r2 = 0.17 to 0.44; p < 0.05), while there was no correlation for 14 and 16 mm diameters (p = 0.48 and p = 0.75). For a typical soft contact lens diameter of 14 mm, 78% of the variance could be determined with a corneal topographer and 68% with keratometry and corneal diameter measurement. CONCLUSIONS The combination of corneal central radii, eccentricity and corneal diameter measured by Placido-based topography is a valid predictor of the corneoscleral sagittal height in healthy eyes. Scleral toricity and axis of the flattest meridian seem to be independent from Placido-based corneal parameters and requires additional measuring tools.
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Affiliation(s)
- Stefan Bandlitz
- Höhere Fachschule für Augenoptik Köln (Cologne School of Optometry), Cologne, Germany.,School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Matthias Lagodny
- Höhere Fachschule für Augenoptik Köln (Cologne School of Optometry), Cologne, Germany
| | - Corinna Kurz
- Höhere Fachschule für Augenoptik Köln (Cologne School of Optometry), Cologne, Germany
| | - James S Wolffsohn
- School of Life and Health Sciences, Aston University, Birmingham, UK
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Macedo-de-Araújo RJ, Fadel D, Barnett M. How Can We Best Measure the Performance of Scleral Lenses? Current Insights. CLINICAL OPTOMETRY 2022; 14:47-65. [PMID: 35418790 PMCID: PMC9000539 DOI: 10.2147/opto.s284632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Scleral lenses (SLs) present several unique advantageous characteristics for patients. As these lenses are mainly fitted in severely diseased eyes, a thorough evaluation of the ocular surface before and after SL fitting and the on-eye SL fitting evaluation are essential and help minimize potential physiological complications. This review will explore the current and emerging techniques and instrumentation to best measure SL performance ensuring optimal lens fitting, visual quality, comfort and physiological responses, highlighting some potential complications and follow-up recommendations. A single physician could perform the great majority of evaluations. Still, the authors consider that the assessment of SL fitting should be a collaborative and multidisciplinary job, involving contact lens practitioners, ophthalmologists and the industry. This publication has reviewed the most up-to-date work and listed the most used techniques; however, the authors encourage the development of more evidence-based recommendations for SL clinical practice.
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Affiliation(s)
- Rute J Macedo-de-Araújo
- Clinical & Experimental Optometry Research Laboratory (CEORLab), Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal
| | | | - Melissa Barnett
- Davis Eye Center, University of California, Sacramento, CA, USA
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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] [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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Niyazmand H, Read SA, Atchison DA. Repeatability of Anterior Eye Surface Topography Parameters from an Anterior Eye Surface Profilometer. Optom Vis Sci 2021; 98:1203-1209. [PMID: 34620781 DOI: 10.1097/opx.0000000000001789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Anterior eye shape measurements are important for clinical contact lens fitting. The detailed assessment of measurement repeatability using the Eye Surface Profiler (ESP; Eaglet Eye B.V., AP Houten, the Netherlands) allows for more reliable interpretation of eye surface topography measurements. PURPOSE This study aimed to determine the repeatability of the ESP for anterior central corneal power and anterior eye surface height measurements. METHODS A Badal optometer was mounted on the ESP to provide an external fixation target with appropriate accommodation control and refractive correction. Forty-five healthy young adults underwent two sessions of anterior eye measurements, separated by 20 minutes, using the ESP. In each session, three consecutive scans were captured. Sagittal height data were obtained from 8-mm central cornea and from 8- to 14-mm diameter (encompassing the corneal periphery and anterior sclera). Anterior corneal powers were determined from the central cornea. Intersessional and intrasessional repeatability values were determined as coefficients of repeatability and root mean square error differences. RESULTS Sagittal height intersessional coefficients of repeatability for central nasal (5 μm) and central temporal (7 μm) were better than peripheral nasal (24 μm) and peripheral temporal (21 μm) regions. Sagittal height intrasessional coefficients of repeatability were 9, 8, 28, and 31 μm for central nasal, central temporal, peripheral nasal, and peripheral temporal regions, respectively. Intersessional coefficients of repeatability of mean sphere, 90/180° (J0) astigmatism, and oblique (J45) astigmatism were 0.67, 0.22, and 0.13 D, respectively, with corresponding intrasessional coefficients of repeatability of 1.27, 0.21, and 0.27 D. CONCLUSIONS The modified measuring procedure for the ESP used in this study provides highly repeatable sagittal height measurements in the central cornea but is less repeatable in the corneal periphery and scleral region. Results of the current study can be considered when using ESP in the interpretation of anterior eye surface shape measurements and in contact lens fitting and design.
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Affiliation(s)
| | - Scott A Read
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland University of Technology, Queensland, Australia
| | - David A Atchison
- Visual and Ophthalmic Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland University of Technology, Queensland, Australia
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Corneoscleral Topography Measured with Fourier-based Profilometry and Scheimpflug Imaging. Optom Vis Sci 2021; 97:766-774. [PMID: 32941338 DOI: 10.1097/opx.0000000000001572] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
SIGNIFICANCE Precise measurement of corneoscleral topography makes a valuable contribution to the understanding of anterior eye anatomy and supports the fitting process of contact lenses. Sagittal height data, determined by newer noninvasive techniques, are particularly useful for initial scleral lens selection. PURPOSE The purpose of this study was to investigate the agreement and repeatability of Fourier-based profilometry and Scheimpflug imaging, in the measurement of sagittal height and toricity of the corneoscleral region. METHODS Minimal (Minsag), maximal (Maxsag) sagittal height, toricity (Maxsag - Minsag), and the maximum possible measurement zone diameter of 38 subjects were compared using the Eye Surface Profiler (ESP; Eagle Eye, Houten, the Netherlands) and the corneoscleral profile module of the Pentacam (Oculus, Wetzlar, Germany) at two different sessions. Correlations between the instruments were analyzed using the Pearson coefficient. Differences between sessions and instruments were analyzed using Bland-Altman and paired t tests. RESULTS For an equal chord length, the measurement with Pentacam was significantly greater for Minsag (344 μm; 95% confidence interval [CI], 322 to 364 μm; P < .001) and significantly greater for Maxsag (280 μm; 95% CI, 256 to 305 μm; P < .001), but significantly smaller for toricity (-63 μm; 95% CI, -95 to -31 μm; P < .001). Maximum possible measurement zone diameter with ESP (16.4 ± 1.3 mm) was significantly greater than with Pentacam (14.8 ± 1.1 mm) (P < .001). Repeated measurements from session 1 and session 2 were not significantly different for Pentacam and ESP (P = .74 and P = .64, respectively). The 95% CIs around differences indicate good repeatability for Pentacam (mean difference, -0.9 μm; 95% CI, -6.7 to 4.8 μm) and ESP (4.6 μm; -22.4 to 31.6). CONCLUSIONS Although both instruments deliver useful data especially for the fitting of scleral and soft contact lenses, the sagittal height and the toricity measurements cannot be considered as interchangeable.
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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: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
Abstract
Scleral lenses were the first type of contact lens, developed in the late nineteenth century to restore vision and protect the ocular surface. With the advent of rigid corneal lenses in the middle of the twentieth century and soft lenses in the 1970's, the use of scleral lenses diminished; in recent times there has been a resurgence in their use driven by advances in manufacturing and ocular imaging technology. Scleral lenses are often the only viable form of contact lens wear across a range of clinical indications and can potentially delay the need for corneal surgery. This report provides a brief historical review of scleral lenses and a detailed account of contemporary scleral lens practice including common indications and recommended terminology. Recent research on ocular surface shape is presented, in addition to a comprehensive account of modern scleral lens fitting and on-eye evaluation. A range of optical and physiological challenges associated with scleral lenses are presented, including options for the clinical management of a range of ocular conditions. Future applications which take advantage of the stability of scleral lenses are also discussed. In summary, this report presents evidence-based recommendations to optimise patient outcomes in modern scleral lens practice.
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Affiliation(s)
- Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, United States.
| | | | | | - Karen Lee
- University of Houston, College of Optometry, Houston, TX, United States
| | | | - Giancarlo Montani
- Università del Salento, Dipartimento di Matematica e Fisica CERCA, Lecce, Italy
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, NL, Netherlands
| | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Brisbane, Australia
| | - Maria Walker
- University of Houston, College of Optometry, Houston, TX, United States
| | - Paramdeep Bilkhu
- School of Optometry & Vision Science, Aston University, Birmingham, United Kingdom
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
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Jandl A, Ruland T, Schwarz D, Wolffsohn JS, Pult H, Bandlitz S. Clinical significance of contact lens related changes of ocular surface tissue observed on optical coherence images. Cont Lens Anterior Eye 2020; 44:101388. [PMID: 33293225 DOI: 10.1016/j.clae.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the relationship between the real contact lens imprint into the conjunctival tissue, observed by optical coherence tomography (OCT) and conjunctival staining and contact lens wearing comfort. METHODS 17 participants (mean age = 26.6 SD ± 3.6 years; 7 females) were fitted with three different contact lenses base curves of the same silicone hydrogel custom lens type (Visell 50; Hecht Contactlinsen, Au, Germany) in a randomised order. One lens was optimally fitted according to the manufacturer's recommendation, one fitted 0.4 mm flatter and one fitted 0.4 mm steeper. After 4 h of lens wear the contact lens edge in the area of the conjunctiva was imaged nasally and temporally using OCT (Optovue iVue SD-OCT). To correct the artefact due to optical distortion with OCT, the imprint of all worn lenses was measured on a glass plate afterwards. Conjunctival staining in the limbal region after 4 h of lens wear was classified using the CCLRU Grading Scale. Comfort scoring was based on visual analog scales from 0 (very poor) to 100 (excellent). RESULTS The mean conjunctival imprint of all contact lens edges was 32.0 ± 8.1 μm before and 7.3 ± 6.5 μm after distortion correction of the OCT images. The distortion corrected conjunctival imprint with the 0.4 mm steeper lens (11.5 ± 6.2 μm) was statistically significantly greater compared to the optimally fitted lens (6.5 ± 5.9 μm) (One-way ANOVA followed Tukey-test; p = 0.017) and greater compared to the 0.4 mm flatter lens (3.9 ± 5.3 μm) (p < 0.001). There was no statistically significant difference between the optimally fitted lens and the 0.4 mm flatter lens (p = 0.209). The nasally measured imprint (11.4 ± 9.0 μm) was significantly greater than the temporally measured (3.3 ± 7.6 μm) (p < 0.001). There was no statistically significant correlation between the amount of conjunctival imprint and the graded conjunctival staining (p = 0.346) or the wearer's comfort (p = 0.735). CONCLUSIONS Contact lens edges imaged by OCT exhibited displacement artefacts. The observed conjunctival imprints are a combination of real conjunctival compression and artefacts. A deeper imprint of the contact lens into the conjunctiva caused by a steeper base curve was not related to clinically significant staining or changes in comfort after 4 h of lens wear. The observed differences between nasal and temporal imprint are likely to be caused by variations of conjunctival thickness and the shape of the underlying sclera.
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Affiliation(s)
- Alexandra Jandl
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany
| | - Thomas Ruland
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany
| | - David Schwarz
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, Aston University, Birmingham, United Kingdom
| | - Heiko Pult
- Optometry and Vision Science Research Group, Aston University, Birmingham, United Kingdom; Dr Heiko Pult - Optometry and Vision Research, Weinheim, Germany; School of Biomedical & Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Stefan Bandlitz
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Cologne, Germany; Optometry and Vision Science Research Group, Aston University, Birmingham, United Kingdom.
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Bataille L, Molina-Martin A, Piñero DP. Intrasession repeatability of corneal, limbal and scleral measurements obtained with a fourier transform profilometer. Cont Lens Anterior Eye 2020; 44:101382. [PMID: 33243586 DOI: 10.1016/j.clae.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the intrasession repeatability of corneal, limbal and scleral measurements obtained by an experienced operator with a Fourier transform profilometer in healthy eyes. METHODS Prospective, single-center study including 35 eyes of 35 participants with ages ranging from 13 to 52 years. All patients underwent three consecutive corneoscleral topographic evaluations with the Eye Surface Profiler (ESP) system (Eaglet Eye b.v.). Intrasession repeatability was analyzed for different geometric and sagittal height variables using the following parameters: the within-subject standard deviation (Sw) of the three consecutive measurements, intrasubject precision (1.96 × Sw), coefficient of variation (CV) and the intraclass correlation coefficient (ICC). RESULTS Inner best fit sphere (BFS) showed good repeatability, with ICC of 0.844. Higher variability was observed for the repeated measurements of limbus and outer BFS, with ICCs of 0.636 and 0.739, respectively. For mean corneal and scleral radius, ICCs were 0.933 and 0.888, respectively. The repeatability of all sagittal height data was good for all chords evaluated (11-15 mm), with Sw values from 0.02 to 0.11 mm, and ICCs from 0.568 to 0.909. A significant positive correlation was found between the magnitude of temporal-nasal sagittal height difference for all measured chords and its Sw associated. CONCLUSION The ESP system can provide consistent measurements of sagittal height data for different chord diameters as well as for mean corneal and scleral radius in healthy eyes. Best fit approaches for limbal and scleral areas were less repeatable, although within a clinically acceptable range.
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Affiliation(s)
- Laurent Bataille
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain
| | - Ainhoa Molina-Martin
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain
| | - David P Piñero
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain; Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain.
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Consejo A, Wu R, Abass A. Anterior Scleral Regional Variation between Asian and Caucasian Populations. J Clin Med 2020; 9:jcm9113419. [PMID: 33113864 PMCID: PMC7692638 DOI: 10.3390/jcm9113419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate the anterior scleral shape regional differences between Asian and Caucasian populations. Methods: The study included 250 Asian eyes and 235 Caucasian eyes from participants aged 22 to 67 years (38.5 ± 7.6). Three-dimensional (3D) corneo-scleral maps were acquired using a corneo-scleral topographer (Eye Surface Profiler, Eaglet Eye BV) and used to calculate sagittal height. For each 3D map, the sclera (maximum diameter of 18 mm) and cornea were separated at the limbus using an automated technique. Advanced data processing steps were applied to ensure levelled artefact-free datasets to build an average scleral shape map for each population. Results: Statistically, Asian and Caucasian sclerae are significantly different from each other in sagittal height (overall sclera, p = 0.001). The largest difference in sagittal height between groups was found in the inferior-temporal region (271 ± 203 µm, p = 0.03), whereas the smallest difference was found in the superior-temporal region (84 ± 105 µm, p = 0.17). The difference in sagittal height between Caucasian and Asian sclera increases with the distance from the limbus. Conclusions: Asian anterior sclera was found to be less elevated than Caucasian anterior sclera. However, the nasal area of the sclera is less elevated than the temporal area, independently of race. Gaining knowledge in race-related scleral topography differences could assist contact lens manufacturers in the process of lens design and practitioners during the process of contact lens fitting.
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Affiliation(s)
- Alejandra Consejo
- Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland;
- Department of Applied Physics, University of Zaragoza, 50009 Zaragoza, Spain
| | - Richard Wu
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung City 40601, Taiwan;
- College of Optometry, Pacific University, Forest Grove, OR 97116, USA
| | - Ahmed Abass
- School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
- Correspondence:
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Bataille L, Piñero DP. Characterization of the geometric properties of the sclero-conjunctival structure: a review. Int J Ophthalmol 2020; 13:1484-1492. [PMID: 32953590 DOI: 10.18240/ijo.2020.09.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
To revise the peer-reviewed literature on geometric properties of the scleral-conjunctival structure in order to define their clinical relevance and the potential relationship between their changes and myopia development or progression. A bibliographic search focused on the study of the geometry of conjunctiva and/or sclera as well as those studies evaluating the relationship between geometric changes in the scleral-conjunctival structure and myopia was carried out. Several studies have been performed with different diagnostic technologies, including optical coherence tomography, profilometry and Scheimpflug imaging, to detect geometric changes of the scleral-conjunctival tissue in different physiological conditions of the eye, after use of contact lenses and in different ocular pathologies. Likewise, these technologies have been shown to be a valuable clinical tool to optimize scleral contact lens fitting. Future studies should investigate new potential clinical applications of such technologies, including the evaluation of anterior scleral changes related to myopia, as well as to define standardized clinical standard operating procedures for obtaining accurate and reproducible clinical measurement of the scleral-conjunctival morphology.
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Affiliation(s)
- Laurent Bataille
- Research and Development Department, VISSUM, Alicante 03016, Spain.,Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante 03690, Spain
| | - David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante 03690, Spain
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Anterior eye shape in emmetropes, low to moderate myopes, and high myopes. Cont Lens Anterior Eye 2020; 44:101361. [DOI: 10.1016/j.clae.2020.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
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Walker MK, Schornack MM, Vincent SJ. Anatomical and physiological considerations in scleral lens wear: Conjunctiva and sclera. Cont Lens Anterior Eye 2020; 43:517-528. [PMID: 32624363 DOI: 10.1016/j.clae.2020.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
Abstract
While scleral lenses have been fitted using diagnostic lenses or impression moulding techniques for over a century, recent advances in anterior segment imaging such as optical coherence tomography and corneo-scleral profilometry have significantly improved the current understanding of the anatomy of the anterior eye including the morphometry of the conjunctiva, sclera, and corneo-scleral junction, as well as the ocular surface shape and elevation. These technological advances in ocular imaging along with continual improvements and innovations in scleral lens design and manufacturing have led to a global increase in scleral lens prescribing. This review provides a comprehensive overview of the conjunctiva and sclera in the context of modern scleral lens practice, including anatomical variations in healthy and diseased eyes, the physiological impact of scleral lens wear, potential fitting challenges, and current approaches to lens modifications in order to minimise lens-induced complications and adverse ocular effects. Specific topics requiring further research are also discussed.
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Affiliation(s)
- Maria K Walker
- University of Houston College of Optometry, The Ocular Surface Institute, Houston, USA
| | | | - 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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Consejo A, Rozema JJ. In vivo anterior scleral morphometry, axial length and myopia. Cont Lens Anterior Eye 2020; 43:21-25. [DOI: 10.1016/j.clae.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/01/2022]
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18
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Fisher D, Collins MJ, Vincent SJ. Anterior segment optical coherence tomography scanning protocols and corneal thickness repeatability. Cont Lens Anterior Eye 2019; 43:433-440. [PMID: 31864901 DOI: 10.1016/j.clae.2019.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the influence of anterior segment optical coherence tomography imaging protocols on the intraobserver and intrasession repeatability of epithelial, stromal, and total corneal thickness measurements. METHODS Repeated anterior segment optical coherence tomography (AS-OCT) images (Spectralis, Heidelberg) were obtained from 15 adults using single 8.3 mm wide horizontal line scans with an average of 2, 10, 20, 30, 50 and 100 B-scans. Volumetric scans consisting of nine 8.3 mm horizontal line scans encompassing a 1.3 mm vertical region were also captured (with 20 B-scans per line scan). Single point thickness measures (at the normal to the tangent of the anterior corneal surface) were compared with thickness measures averaged over the central 6 mm. The impact of B-scan averaging and intraobserver variability were examined for single line scans. For volumetric scans, the impact of the number of line scans upon intraobserver and intrasession variability were calculated. RESULTS Intraobserver repeatability did not vary significantly as a function of the number of averaged B-scans per line scan, but was lowest for 20-30 averaged B scans. For volumetric scans, increasing the number of line scans did increase scan duration (p < 0.001), with minimal impact upon the average scan quality index (p = 0.06). Averaging more than 3 line scans did not significantly improve intraobserver or intrasession repeatability for either single point or average thickness measurements. CONCLUSION AS-OCT volumetric scans with 3 lines each consisting of 20 B-scans with measurements averaged over a central 6 mm of the cornea provide highly repeatable measures of epithelial, stromal and total corneal thickness (95 % LoA ≤ ±3.2 μm for intraobserver repeatability and ≤ ±3.7 μm for intrasession repeatability). This scanning protocol can provide reliable information when monitoring subtle changes in corneal thickness.
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Affiliation(s)
- Damien Fisher
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Australia.
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Australia
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Australia
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20
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Abass A, Lopes BT, Eliasy A, Salomao M, Wu R, White L, Jones S, Clamp J, Ambrósio R, Elsheikh A. Artefact-free topography based scleral-asymmetry. PLoS One 2019; 14:e0219789. [PMID: 31348792 PMCID: PMC6660081 DOI: 10.1371/journal.pone.0219789] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To present a three-dimensional non-parametric method for detecting scleral asymmetry using corneoscleral topography data that are free of edge-effect artefacts. METHODS The study included 88 participants aged 23 to 65 years (37.7±9.7), 47 women and 41 men. The eye topography data were exported from the Eye Surface Profiler software in MATLAB binary data container format then processed by custom built MATLAB codes entirely independent from the profiler software. Scleral asymmetry was determined initially from the unprocessed topography before being determined again after removing the edge-effect noise. Topography data were levelled around the limbus, then edge-effect was eliminated using a robust statistical moving median technique. In addition to comparing raw elevation data, scleral elevation was also compared through fitting a sphere to every single scleral surface and determining the relative elevation from the best-fit sphere reference surface. RESULTS When considering the averaged raw topography elevation data in the scleral section of the eye at radius 8 mm, the average raw elevations of the right eyes' sclera were -1.5±1.77, -1.87±2.12, -1.36±1.82 and -1.57±1.87 mm. In the left eyes at the same radius the average raw elevations were -1.62±1.78, -1.82±2.07, -1.28±1.76 and -1.68±1.93 mm. While, when considering the average raw elevation of the sclera after removing the edge effect, the average raw elevations of the right eyes were -3.71±0.25, -4.06±0.23, -3.95±0.19 and -3.95±0.23 mm. In the left eyes at the same radius the average raw elevations were -3.71±0.19, -3.97±0.22, -3.96±0.19 and -3.96±0.18 mm in the nasal, temporal, superior and inferior sides respectively. Maximum raw elevation asymmetry in the averaged scleral raw elevation was 1.6647±0.9015 mm in right eyes and 1.0358±0.6842 mm in left eyes, both detected at -38° to the nasal side. Best-fit sphere-based relative elevation showed that sclera is more elevated in three main meridians at angles -40°, 76°, and 170° in right eyes and -40°, 76°, and 170° in left eyes, all measured from the nasal meridian. Maximum recorded relative elevation asymmetries were 0.0844±0.0355 mm and 0.068±0.0607 mm at angular positions 76° and 63.5° for right and left eyes in turn. CONCLUSIONS It is not possible to use corneoscleral topography data to predict the scleral shape without considering a method of removing the edge-effect from the topography data. The nasal side of the sclera is higher than the temporal side, therefore, rotationally symmetric scleral contact lenses are more likely to be translated towards the temporal side. The scleral shape is best described by levelled raw elevation rather than relative elevation.
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Affiliation(s)
- Ahmed Abass
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Bernardo T. Lopes
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- Federal University of São Paulo, São Paulo, Brazil
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | | | - Richard Wu
- Central Taiwan University of Science and Technology, Taichung, Taiwan
- Pacific University, College of Optometry, Forest Grove, Oregon, United States of America
| | - Lynn White
- UltraVision CLPL, Leighton Buzzard, United Kingdom
| | - Steve Jones
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - John Clamp
- UltraVision CLPL, Leighton Buzzard, United Kingdom
| | - Renato Ambrósio
- Federal University of São Paulo, São Paulo, Brazil
- Federal University of the State of Rio de Janeiro, RJ, Brazil
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- School of Biological Science and Biomedical Engineering, Beihang University, Beijing, China
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21
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Developments in Contact Lens Imaging: New Applications of Optical Coherence Tomography. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a high-speed and non-contact optical imaging technology widely used for noninvasive cross-sectional imaging of biological objects. Two main OCT technologies have been developed: time domain and Fourier domain technologies. The latter can be further divided into spectral domain OCT, which uses a broadband light source and a spectrometer as a detector, and swept source OCT, which employs a quickly-rotating laser source. Advances in OCT technology have made it one of the most helpful devices in ophthalmic practice. Fourier OCT has revolutionized imaging of the posterior segment of the eye, as well as of anterior structures and has enhanced the ability to diagnose and manage patients. It provides high-resolution information about the tear film, contact lens (CL), a qualitative and quantitative assessment of the anterior eye that is important in contact lens fitting, and allows possible eye surface changes while wearing contact lenses to be monitored. Potential swept source OCT technology applications include industrial processes of lens design and quality control. In this paper, we describe clinical applications and outline a variety of multifunctional uses of OCT in the field of refractive error correction with contact lenses.
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Characterization of Corneoscleral Geometry Using Fourier Transform Profilometry in the Healthy Eye. Eye Contact Lens 2019; 45:201-207. [DOI: 10.1097/icl.0000000000000560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Macedo-de-Araújo RJ, van der Worp E, González-Méijome JM. In vivo assessment of the anterior scleral contour assisted by automatic profilometry and changes in conjunctival shape after miniscleral contact lens fitting. JOURNAL OF OPTOMETRY 2019; 12:131-140. [PMID: 30393001 PMCID: PMC6449784 DOI: 10.1016/j.optom.2018.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To compare the shape of the anterior sclera of candidates to scleral lens (ScCL) fitting with regular and irregular corneas and analyze the changes induced in the shape of the sclero-conjunctiva after ScCL wear. METHODS Thirty-five eyes of 18 subjects (19 eyes with irregular corneas and 16 with regular corneas) were consecutively recruited. Three measures of sclero-conjunctival shape were taken with Eye Surface Profiler (ESP, Eaglet Eye, Houten, The Netherlands). Tangent angles and ocular sagittal heights (OC-SAG) were analyzed at different chords from 13 to 17mm in the nasal, temporal, superior and inferior regions. The 19 eyes with irregular cornea were selected to wear ScCL and the changes in their sclero-conjunctival surface parameters were compared before and after 3h of lens wear. RESULTS Irregular corneas showed higher OC-SAG values than regular corneas in all the chords analyzed, with statistical significant differences in the temporal region. Regarding tangent angles, regular corneas showed lower values (flatter surface), with statistical significant differences at 8 and 8.50mm on the nasal and 8.50mm on the temporal region. Some changes were seen in sclero-conjuctival shape after short-term ScCL wear. There was an augment in OC-SAG after 3h of scleral lens wear and a reduction on tangent angles, namely on the nasal region at 7.5mm and 8.00mm chord lengths, which is coincidental with the landing zone of ScCL. CONCLUSIONS ESP shows mild differences in scleral shape between eyes with regular and irregular corneas. ESP might be valuable in quantifying the mechanical impact of the ScCL on the anterior eye surface.
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Affiliation(s)
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, The Netherlands
| | - José Manuel González-Méijome
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
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Consejo A, Llorens‐Quintana C, Bartuzel MM, Iskander DR, Rozema JJ. Rotation asymmetry of the human sclera. Acta Ophthalmol 2019; 97:e266-e270. [PMID: 30146759 DOI: 10.1111/aos.13901] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 07/20/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To characterize the mean topographical shape of the human sclera of a normal eye. METHODS Forty-five participants aged from 19 to 45 years and with no previous ocular surgeries were included in this study. Four three-dimensional (3D) corneo-scleral maps from both eyes were acquired using a corneo-scleral topographer (Eye Surface Profiler). For each 3D map, the sclera (maximum diameter of 16 mm) and cornea were automatically separated at the level of the limbus. The remaining 3D scleral ring was further fit to a quadratic function. The elevation difference between the original and fit data was calculated. For statistical analysis, sclera was divided into eight sectors: nasal, temporal, superior, inferior, supero-nasal, supero-temporal, inferior-nasal and inferior-temporal. In addition, sclera was separated as inner sclera (inner ring of 6-7-mm radius) and outer sclera (external ring of 7-8-mm radius). RESULTS Horizontally, the nasal area of the sclera showed less elevation [mean (SD) -30 (52) μm (OD)] than the temporal area [mean (SD) 4 (47) μm (OD)], p < 0.001. Vertically, the inferior area of the sclera [mean (SD) 32 (72) μm (OD)] was slightly less elevated than the superior area (mean (SD) 36 (84) μm, but this difference was not statistically significant (p = 0.40). Besides, the asymmetry of the sclera was found to increase with radial distance from the corneal apex. No statistically significant difference was found between right and left eye. CONCLUSION Human sclera is rotationally asymmetric, and its shape varies considerably between subjects.
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Affiliation(s)
- Alejandra Consejo
- Department of Ophthalmology Antwerp University Hospital Edegem Belgium
- Department of Biomedical Engineering Wroclaw University of Science and Technology Wroclaw Poland
- Department of Medicine and Health Sciences University of Antwerp Antwerp Belgium
| | - Clara Llorens‐Quintana
- Department of Biomedical Engineering Wroclaw University of Science and Technology Wroclaw Poland
| | - Maciej M. Bartuzel
- Department of Biomedical Engineering Wroclaw University of Science and Technology Wroclaw Poland
| | - D. Robert Iskander
- Department of Biomedical Engineering Wroclaw University of Science and Technology Wroclaw Poland
| | - Jos J. Rozema
- Department of Ophthalmology Antwerp University Hospital Edegem Belgium
- Department of Medicine and Health Sciences University of Antwerp Antwerp Belgium
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Anterior eye surface changes following miniscleral contact lens wear. Cont Lens Anterior Eye 2019; 42:70-74. [DOI: 10.1016/j.clae.2018.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/16/2022]
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26
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Relationship of placido corneal topography data with scleral lens fitting parameters. Cont Lens Anterior Eye 2019; 42:20-27. [DOI: 10.1016/j.clae.2018.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022]
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Consejo A, Behaegel J, Van Hoey M, Iskander DR, Rozema JJ. Scleral asymmetry as a potential predictor for scleral lens compression. Ophthalmic Physiol Opt 2018; 38:609-616. [DOI: 10.1111/opo.12587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Alejandra Consejo
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Biomedical Engineering; Wroclaw University of Science and Technology; Wroclaw Poland
| | - Joséphine Behaegel
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Ophthalmology; Brussels University Hospital; Jette Belgium
| | - Maarten Van Hoey
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
| | - D Robert Iskander
- Department of Biomedical Engineering; Wroclaw University of Science and Technology; Wroclaw Poland
| | - Jos J Rozema
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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The influence of limbal and scleral shape on scleral lens design. Cont Lens Anterior Eye 2018; 41:321-328. [DOI: 10.1016/j.clae.2018.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/19/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
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Vincent SJ, Alonso-Caneiro D, Collins MJ. Optical coherence tomography and scleral contact lenses: clinical and research applications. Clin Exp Optom 2018; 102:224-241. [PMID: 30062745 DOI: 10.1111/cxo.12814] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/20/2018] [Accepted: 06/24/2018] [Indexed: 12/30/2022] Open
Abstract
Anterior segment optical coherence tomography (OCT) provides a wealth of opportunities for modern contact lens practice. OCT imaging has numerous clinical and research applications related to the tear film, cornea, conjunctiva, sclera and ocular adnexae, in addition to soft, rigid, and hybrid contact lenses. This review summarises the potential use of OCT imaging in modern scleral contact lens practice including initial lens selection, assessing the scleral contact lens fit with respect to the cornea and sclera, and accurately quantifying the ocular response to lens wear. Recent advances in the understanding of anterior segment metrics including scleral thickness, curvature, toricity, and the anatomy of the corneoscleral limbal junction are also discussed.
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Affiliation(s)
- Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Sridhar MS, Martin R. Anterior segment optical coherence tomography for evaluation of cornea and ocular surface. Indian J Ophthalmol 2018; 66:367-372. [PMID: 29480245 PMCID: PMC5859589 DOI: 10.4103/ijo.ijo_823_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple. Several devices and technologies allow to explore and manage patients better. Optical coherence tomography (OCT) technology has evolved over the years, and hence a detailed evaluation of anterior segment (AS) structures such as cornea, conjunctiva, tear meniscus, anterior chamber, iris, and crystalline lens has been possible in a noncontact and safe procedure. The purpose of this special issue is to present and update in the evaluation of cornea and ocular surface, and this paper reviews a description of the AS-OCT, presenting the technology and common clinical uses of OCT in the management of diseases involving cornea and ocular surface to provide an updated information of the clinical recommendations of this technique in eye care practice.
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Affiliation(s)
- Mittanamalli S Sridhar
- Department of Ophthalmology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raul Martin
- Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid; Instituto Universitario de Oftalmobiología Aplicada, Universidad de Valladolid; School of Optometry, IOBA Eye Institute, University of Valladolid, Valladolid, Spain; Faculty of Health and Human Sciences, Plymouth University, PL6 8BH Plymouth, England
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Andreanos KD, Hashemi K, Petrelli M, Droutsas K, Georgalas I, Kymionis GD. Keratoconus Treatment Algorithm. Ophthalmol Ther 2017; 6:245-262. [PMID: 28755306 PMCID: PMC5693837 DOI: 10.1007/s40123-017-0099-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Indexed: 11/25/2022] Open
Abstract
Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.
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Affiliation(s)
- Konstantinos D Andreanos
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece.
| | - Kate Hashemi
- Faculty of Biology and Medicine, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Myrsini Petrelli
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Droutsas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - George D Kymionis
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
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