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Yang X, Wang Y, Liu Y, Lyu Y, Wang W. Longitudinal assessment of the progression of severe keratoconus based on corneal topography. Sci Rep 2024; 14:19642. [PMID: 39179596 PMCID: PMC11344030 DOI: 10.1038/s41598-024-70084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
We aimed to assess long-term disease progression in patients with severe keratoconus (KC). Clinical records of 125 patients (201 eyes) with severe KC followed-up for > 12 months were retrospectively analyzed. From these, 28 patients (31 eyes) were included. Corneal topography parameters evaluated included thinnest corneal thickness (TCT), maximum keratometry (Kmax), anterior and posterior mean corneal radii of 3 mm (aKM, pKM), steep keratometry, and KC screening indices. All patients wore rigid gas permeable contact lenses (RGPCLs) for an extended period. The median patient age and follow-up period were 20 (interquartile range [IQR] 17-22) years and 25 (15-38) months, respectively. Compared to baseline, the aKM, Kmax, and KC screening indices on the anterior corneal surface were reduced at the final follow-up (P < 0.05). No changes were observed in RGP-corrected visual acuity, TCT, pKM, or KC screening indices on the posterior corneal surface. The higher the baseline value, the greater the reduction in aKM and Kmax. Five patients (16%) experienced disease progression during follow-up. Patients with severe KC showed reduced anterior corneal surface curvature and no change in corneal thickness during an average follow-up period of 2-3 years while wearing RGPCLs.
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Affiliation(s)
- XiaoDi Yang
- The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450000, China.
| | - YiRan Wang
- The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450000, China
| | - YuYing Liu
- The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450000, China
| | - Yong Lyu
- The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450000, China
| | - WeiQun Wang
- The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450000, China.
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Sinha R, Anjum S, Dwivedi S, Agarwal R, Bari A. Mini-Scleral Lens: An Effective Mode of Visual Rehabilitation in Eyes With Resolved Hydrops. Eye Contact Lens 2024; 50:361-367. [PMID: 38886964 DOI: 10.1097/icl.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To evaluate the visual outcome of mini-scleral contact lenses (MSLs) in keratoconus following the resolution of acute hydrops. METHODS This was a prospective observational case series of patients of healed hydrops in keratoconus fitted with an MSL (Keracare, Acculens, Lakewood, CO) who were managed for acute hydrops medically or surgically at least 3 months prior. Uncorrected visual acuity, best spectacles-corrected visual acuity, best lens-corrected visual acuity, topographic indices, keratometric indices, contact lens parameters, and ocular aberrometric changes were evaluated. All patients were followed up for at least 3 months. RESULTS Eighteen eyes of 17 patients were included in the analysis. The mean post-hydrops topographic values of the eyes included flat keratometric value (K1) 64.93±10.88 (range 44.30-93.40) diopters (D), steep keratometric value (K2) 70.41±10.92 D (range 45.8-98.6 D), and Kmax of 79.53±17.73 D (range 50-130.2). The final mini-scleral lens's mean dioptric power was -8.56±3.96 D (range -18 to -4). Visual acuity significantly improved from post-hydrops resolution uncorrected visual acuity of 1.5±0.71 logMAR to 0.79±0.18 logMAR best spectacles-corrected visual acuity to 0.27±0.01 logMAR best lens-corrected visual acuity ( P -value <0.0001). Similarly, there was considerable improvement in corneal aberrometric values after wearing an MSL. At the 3-month follow-up, 15 patients (16 eyes) were compliant to contact lens use with a minimum of 6 to 8 hr daily while two patients (2 eyes) were poorly compliant. CONCLUSIONS A MSL is a valuable option for visual rehabilitation in keratoconus following the resolution of acute hydrops.
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Affiliation(s)
- Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Applegate RA, Hastings GD, Jiménez-García M, Francis S, Koppen C, Rozema JJ. Allowable movement of wavefront-guided contact lens corrections in normal and keratoconic eyes. Ophthalmic Physiol Opt 2024; 44:746-756. [PMID: 38389207 DOI: 10.1111/opo.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE The goal was to use SyntEyes modelling to estimate the allowable alignment error of wavefront-guided rigid contact lens corrections for a range of normal and keratoconic eye aberration structures to keep objectively measured visual image quality at or above average levels of well-corrected normal eyes. Secondary purposes included determining the required radial order of correction, whether increased radial order of the corrections further constrained the allowable alignment error and how alignment constraints vary with keratoconus severity. METHODS Building on previous work, 20 normal SyntEyes and 20 keratoconic SyntEyes were fitted with optimised wavefront-guided rigid contact lens corrections targeting between three and eight radial orders that drove visual image quality, as measured objectively by the visual Strehl ratio, to near 1 (best possible) over a 5-mm pupil for the aligned position. The resulting wavefront-guided contact lens was then allowed to translate up to ±1 mm in the x- and y-directions and rotate up ±15°. RESULTS Allowable alignment error changed as a function of the magnitude of aberration structure to be corrected, which depends on keratoconus severity. This alignment error varied only slightly with the radial order of correction above the fourth radial order. To return the keratoconic SyntEyes to average levels of visual image quality depended on maximum anterior corneal curvature (Kmax). Acceptable tolerances for misalignment that returned keratoconic visual image quality to average normal levels varied between 0.29 and 0.63 mm for translation and approximately ±6.5° for rotation, depending on the magnitude of the aberration structure being corrected. CONCLUSIONS Allowable alignment errors vary as a function of the aberration structure being corrected, the desired goal for visual image quality and as a function of keratoconus severity.
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Affiliation(s)
| | | | - Marta Jiménez-García
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Sharon Francis
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Carina Koppen
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Jos J Rozema
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Serramito M, Privado-Aroco A, Carracedo G. Anterior, Posterior, and Thickness Cornea Differences after Scleral Lens Wear in Post-LASIK Subjects for One Year. Healthcare (Basel) 2023; 11:2922. [PMID: 37998414 PMCID: PMC10671115 DOI: 10.3390/healthcare11222922] [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: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.
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Affiliation(s)
- Maria Serramito
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Ana Privado-Aroco
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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Vilà Porsell I, Rodriguez Lopez A, Rocha-de-Lossada C, Rachwani Anil R, Sánchez Valera M. Evidence of Contact Lenses for Vision Rehabilitation in Corneal Diseases: A Review. Eye Contact Lens 2023; 49:301-309. [PMID: 37319415 DOI: 10.1097/icl.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of contact lenses (CL) as a therapeutic option for patients affected by a corneal disease and to determinate which is the best lens modality for each disease. METHODS A literature review using PubMed was performed. All relevant articles published during the last 15 years have been included. RESULTS Various studies point to CL as the best therapeutic option for some corneal diseases and even as an alternative to surgery in some cases. After fitting, patients show an improvement in their functional vision and quality of life, in some cases being able to drive or work again. CONCLUSIONS There is a lack of scientific evidence to determine which lens modality is suitable for each corneal pathology. Currently, according to this review, the reason for choosing between the different options depends on the severity of symptoms, and it is worth mentioning that scleral lenses seem to be the best option in advanced stages of disease. However, the expertise of professionals is also an important factor at the time of choosing a particular CL modality. Standardized criteria are still necessary for correct selection of lens modality for a correct management of the disease.
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Affiliation(s)
- Irene Vilà Porsell
- Hospital Clinic de Barcelona (I.V.P., A.R.L., M.S.V.), Barcelona, Spain; Department of Ophthalmology (C.R.d.L.), Qvision, VITHAS Almería Hospital, Almería, Spain; Department of Ophthalmology (C.R.d.L.), Vithas Málaga, Málaga, Spain; Department of Ophthalmology (C.R.d.L.), Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Cirugía (C.R.d.L.), Universidad de Sevilla, Área de Oftalmología; Department of Ophthalmology (R.R.A.), Hospital Norte de Málaga, Antequera, Spain; Department of Ophthalmology (R.R.A.), Hospital Quirón Málaga, Spain; Department of Ophthalmology (R.R.A.), Hospital Vithas Málaga, Spain
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Sidi Mohamed Hamida A, Marta GB, Pedro RF, Piñero DP. Characterization and prediction of the clinical result with a specific model of mini-scleral contact lens in corneas with keratoconus. EYE AND VISION (LONDON, ENGLAND) 2022; 9:39. [PMID: 36199152 PMCID: PMC9536044 DOI: 10.1186/s40662-022-00310-5] [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: 04/24/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Background To investigate which factors are correlated with the visual improvement achieved with a specific model of scleral contact lens (SCL) in keratoconus (KC) eyes and to define a model to predict such improvement according to the pre-fitting data. In addition, the changes occurred with the fitting of a specific model of SCL during a period of 3 months in corneas with KC have been investigated. Methods Longitudinal retrospective study including 30 eyes of 18 patients (age, 14–65 years) with KC fitted with the SCL ICD16.50 (Paragon Vision Sciences). Visual, refractive, corneal tomographic and ocular aberrometric changes were evaluated during a 3-month follow-up. Likewise, the characterization of the post-lens meniscus was performed by optical coherence tomography (OCT) with the measurement of central, nasal and temporal vaults. Results The visual acuity increased significantly from a mean pre-fitting value with spectacles of 0.23 ± 0.07 logarithm of minimal angle of resolution (logMAR) to a mean value of 0.10 ± 0.04 logMAR after 1 month of SCL wear (P < 0.001). An improvement of 1 or more lines of visual acuity with the SCL occurred in 62.1% of the eyes. A significant decrease in central, nasal, and temporal vault was observed after 1 month of SCL wear (P ≤ 0.046). Likewise, there was a significant difference between nasal and temporal vaults during the first month of SCL use (P = 0.008). Furthermore, a significant reduction of ocular high order (P = 0.028) and primary coma root mean square (P = 0.018) was found with the SCL. A predicting linear equation of the change in visual acuity achievable with the SCL was obtained (P < 0.001, R2 = 0.878) considering the pre-fitting spectacle corrected distance visual acuity, and the power and sagittal lens of SCL. Conclusions The scleral contact lens evaluated provides an efficacious visual rehabilitation in KC due to the improvement of visual acuity and the correction of low and high-order ocular aberrations. This visual acuity improvement can be predicted from some pre-fitting variables.
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Affiliation(s)
| | - García-Barchín Marta
- grid.5268.90000 0001 2168 1800Group of Optics and Visual Perception, Department of Optics, Pharmacology, and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, 03690 Alicante, Spain
| | - Ruiz-Fortes Pedro
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain
| | - David P. Piñero
- grid.5268.90000 0001 2168 1800Group of Optics and Visual Perception, Department of Optics, Pharmacology, and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n 03016, San Vicente del Raspeig, 03690 Alicante, Spain ,Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain
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Oh MS, Kang MS, Park SH, Lee JE. Effectiveness of More than 2-Year Treatment with Miniscleral Contact Lens in Ocular Surface Diseases: Four Case Reports. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:376-378. [PMID: 35959548 PMCID: PMC9388894 DOI: 10.3341/kjo.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Min Sung Oh
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Seung Kang
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Hwan Park
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- E-mail (Ji Eun Lee):
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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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Sheludchenko VM, Yusef YN, Osipyan GA, Dzhalili RA. [Opto-functional results in keratoconus patients after intrastromal keratoplasty]. Vestn Oftalmol 2022; 138:196-202. [PMID: 36287155 DOI: 10.17116/oftalma2022138052196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Intrastromal keratoplasty with allograft implantation can stop the progression of keratoconus (KC) and improve visual acuity (VA). Although optimization of keratometric parameters and an increase in VA improve the quality of vision (QoV), there are other indicators that affect the QoV and the quality of life (QoL) of patients and require further study. PURPOSE Analysis of quantitative and qualitative characteristics of vision in patients with stage II and III keratoconus who underwent intrastromal allokeratoplasty. MATERIAL AND METHODS The study included 15 patients (15 eyes) with stage II-III KC (Amsler-Krumeich classification) aged 17 to 38 years old (28.8±6.2). All patients underwent intrastromal keratoplasty with implantation of an allograft in the form of a wide incomplete ring. The following parameters were assessed before and 6 months after surgery: distance VA with and without correction, near VA with and without correction, VA with glare effect, high-order aberrations (HOA), thickness of the tear film lipid layer, spatial contrast sensitivity (SCS) under photopic and mesopic conditions with light filters, reading speed. RESULTS VA without correction increased from 0.15 to 0.7; with correction from 0.35 to 0.7. The glare effect with varying degrees of illumination did not affect VA either before or after surgery. Statistically significant changes were observed when comparing the aberrations «coma», «spherical», «trefoil» before and after the intervention, they became inverted. The thickness of the tear film lipid layer did not change significantly when comparing pre- and postoperative data. The use of light filters (orange, yellow) did not lead to significant changes in the VA and SCS under photopic and mesopic conditions. CONCLUSION The use of a wide intrastromal allograft to correct deformity and stabilize the cornea in keratoconus improves the patients' quality of vision and visual performance.
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Affiliation(s)
| | - Yu N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Dzhalili
- Research Institute of Eye Diseases, Moscow, Russia
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Sheludchenko VM, Yusef YN, Osipyan GA, Dzhalili RA. [Changes in the quality of vision after intrastromal allokeratoplasty for keratoconus (clinical observation)]. Vestn Oftalmol 2022; 138:87-93. [PMID: 36288422 DOI: 10.17116/oftalma202213805187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Scleral lenses, corneal collagen crosslinking, corneal implants and deep anterior keratoplasty are used to correct deforming changes in the cornea at advanced stages of keratoconus, which improves the quality of vision (QoV). The article presents an analysis of changes in QoV in a 30-year-old patient with stage III keratoconus who underwent intracorneal implantation of an allograft with a width of 2.75 mm and thickness of 300 µm at a depth of 370 µm. The following parameters were measured before and 6 months after the procedure: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), VA with glare, higher order aberrations (HOA), thickness of the lipid layer of the tear film, spatial contrast sensitivity, visual productivity. Observation results show that the Kmax index decreased from 55.9 D to 48.0 D, Kmin - from 39.8 D to 39.4 D, UCVA increased from 0.1 to 0.8 and BCVA - from 0.35 to 0.8. Thickness of the lipid layer of the tear film remained the same. The glare effect with different degrees of brightness did not affect visual acuity. Spatial contrast sensitivity in photopic conditions at medium frequencies increased from 19 to 37 dB, at high frequencies from - 0.5 to 22.5 dB, in mesopic conditions at medium frequencies from 11 to 28 dB, at high frequencies from - 0.5 to 12 dB. The «coma» and «spherical» aberrations decreased by 2 and 3 times, respectively, while «trefoil» increased by 3 times. Visual productivity increased by 36.8%. It may be concluded that the use of a wide intrastromal allograft in keratoconus improves the patient's visual quality and visual productivity. At the same time, the «vignetting» effect from the graft side is negligible in photopic conditions and is significant in mesopic conditions.
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Affiliation(s)
| | - Yu N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - R A Dzhalili
- Research Institute of Eye Diseases, Moscow, Russia
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Marta A, Marques JH, Almeida D, José D, Barbosa I. Keratoconus and Visual Performance with Different Contact Lenses. Clin Ophthalmol 2021; 15:4697-4705. [PMID: 34949911 PMCID: PMC8689658 DOI: 10.2147/opth.s345154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the visual performance in contact lens wearers with keratoconus. Methods A retrospective study including contact lens (CL) wearers was performed. The current best-corrected visual acuity with contact lens (BCVA-CL) and with spectacles (BCVA-S) correction, contrast sensitivity (CS) (by Metrovision-MonPack3®), analysis of light scattering in the retina and vision break-up time (HD Analyzer®), and corneal tomography (Oculus Pentacam® HR) were evaluated. Results This study included 96 eyes of 59 patients with Keratoconus. Rigid gas permeable contact lenses (RGPCL), hybrid contact lenses (HCL), and silicone hydrogel/hydrogel contact lenses (HGCL) were fitted in 67, 17, and 12 eyes, respectively. Dynamic objective scatter index (OSI) (p = 0.024), minimum OSI (p = 0.037) and maximum OSI (p = 0.040) were significantly better with RGPCL and worse with HGCL. Mean CS in photopic conditions was significantly worse with HGCL and better with HCL (p = 0.006), without differences in mesopic conditions (p = 0.121). RGPCL wearers showed a higher mean K (p = 0.020), and a lower corneal thickness at the thinnest point (p=0.011). Conclusion Visual quality varied significantly with different types of CL. Although RGPCL was fitted in patients with worse Pentacam tomographic parameters, RGPCL was associated with a better dynamic visual quality.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - João Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Daniel Almeida
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Irene Barbosa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Amorim-de-Sousa A, Macedo-de-Araújo R, Fernandes P, Queirós A, González-Méijome JM. Multifocal Electroretinogram in Keratoconus Patients without and with Scleral Lenses. Curr Eye Res 2021; 46:1732-1741. [PMID: 33823736 DOI: 10.1080/02713683.2021.1912781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To investigate changes in the multifocal electroretinogram (mfERG) response in eyes with keratoconus when corrected with scleral lenses (SL) compared with the best correction in glasses.Methods: The mfERG responses in 10 eyes with keratoconus were recorded with the best correction using both a trial frame (baseline) and a hexafocon A SL using an electrophysiological diagnostic system. Electrophysiologic measurements were performed with the pupils fully dilated with instillation of 1% phenylephrine. The implicit time (milliseconds), amplitude (nV), and response density (nV/deg2) of the peaks (N1, P1, and N2) were analyzed for the total mfERG response, six rings and four quadrants of the retina, and compared between the two conditions.Results: All eyes had a significant improvement in visual quality with the SL compared with baseline (mean differences, 0.26 ± 0.17 and 0.22 ± 0.13 logarithm of the minimum angle of resolution for high- and low-contrast visual acuity, respectively). The peaks implicit times of the mfERG responses did not show significant differences (p > .05). The P1 amplitude decreased in all the retinal areas with the SL. Only the total retinal response and the nasal quadrants reached significance (p ≤ 0.044). The P1 response density in ring 1 was on average higher with the SL, but not significantly so. The decline in P1 response density from the center to the periphery was more abrupt with the SL, and was more similar to the response density distribution of a typical subject, without a corneal pathology.Conclusions: mfERG did not show any change associated with retinal disease in young patients with keratoconus. Although the improved visual performance was not associated with changes in the mfERG response, the correction of irregular astigmatism with the SL helps exclude the optical effect induced by keratoconus.
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Affiliation(s)
- Ana Amorim-de-Sousa
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - Rute Macedo-de-Araújo
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - Paulo Fernandes
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - António Queirós
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - José M González-Méijome
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
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13
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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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14
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Formisano M, Franzone F, Alisi L, Pistella S, Spadea L. Effects of Scleral Contact Lenses for Keratoconus Management on Visual Quality and Intraocular Pressure. Ther Clin Risk Manag 2021; 17:79-85. [PMID: 33531812 PMCID: PMC7846850 DOI: 10.2147/tcrm.s293425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. Methods In a prospective case series a comparison was made between visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann Applanation Tonometer (GAT) before and after scleral CL wear. Results The mean logMAR visual acuity improved from 0.2±0.25SD with glasses and 0.1±0.02SD with RGP, to −0.002±0.041SD when using the scleral CL (p<0.05). The mean IOP value before scleral CL wear was 12.93mmHg±2.20SD when measured with GAT and 7.85mmHg±2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg±2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ±2.40SD and the mean IOP measured with DT was 7.66mmHg±1.88SD. Therefore, during scleral CL wear, it was evidenced a small but statistically significant increase of the mean IOP value (1.01mmHg; p<0.01), with a reversion to values prior to application when scleral CL was removed. Conclusion Scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. Even if it was evidenced a small increase of the mean IOP value during their wear, it may not be significant in otherwise healthy eyes. Statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap, that should be taken into account when there is a need to relate the DT values to the reference ones.
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Affiliation(s)
- Martina Formisano
- Eye Clinic, Department of Sense Organs, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Federica Franzone
- Eye Clinic, Department of Sense Organs, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Ludovico Alisi
- Eye Clinic, Department of Sense Organs, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Santino Pistella
- Eye Clinic, Department of Sense Organs, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Leopoldo Spadea
- Eye Clinic, Department of Sense Organs, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
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15
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Bae SH, Chun YS, Kim KW. Changes in Mini-scleral Lens Parameters after Repetitive Ethylene Oxide Sterilization. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Kumar P, Bandela PK, Bharadwaj SR. Do visual performance and optical quality vary across different contact lens correction modalities in keratoconus? Cont Lens Anterior Eye 2020; 43:568-576. [DOI: 10.1016/j.clae.2020.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 11/28/2022]
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17
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A model of visual limitation in patients with keratoconus. Sci Rep 2020; 10:19335. [PMID: 33168906 PMCID: PMC7652865 DOI: 10.1038/s41598-020-76489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/29/2020] [Indexed: 11/08/2022] Open
Abstract
This paper aims to calculate a relevance model of visual limitation (V.L.) in keratoconus patients based on refractive and topographic parameters. A cross-sectional study was carried out in Torrecárdenas Hospital, Almería, Spain, between February 2018 and July 2019. It included 250 keratoconus patients. Two groups were created according to a grading system of V.L. based on RETICS (Red Temática de Investigación Cooperativa en Salud) classification: keratoconus patients with no V.L. (best spectacle-corrected visual acuity (BSCVA) ≤ 0.05 logMAR) and keratoconus patients with V.L. (BSCVA > 0.05 logMAR). Correlations and a binary logistic regression were established. V.L. was correlated with maximum curvature (r = 0.649, p < 0.001) and root mean square higher-order aberrations (HOARMS) (r = 0.625, p < 0.001). Binary logistic regression included V.L. as the dependent variable and spherical equivalent, HOARMS, spherical aberration and interaction between the anterior and posterior vertical coma as independent variables. The model was a good fit. Area under the curve (A.U.C.) of receiver operating characteristic (R.O.C.) curve was 0.924, sensitivity 91.90%, specificity 83.60%, accuracy 88.94%; and precision 91.17%. Binary logistic regression model of V.L. is a good fit model to predict the early loss of visual acuity in keratoconus patients.
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Macedo-de-Araújo RJ, Faria-Ribeiro M, McAlinden C, van der Worp E, González-Méijome JM. Optical Quality and Visual Performance for One Year in a Sample of Scleral Lens Wearers. Optom Vis Sci 2020; 97:775-789. [DOI: 10.1097/opx.0000000000001570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Montalt JC, Porcar E, España-Gregori E, Peris-Martínez C. Corneoscleral contact lenses for visual rehabilitation after keratoplasty surgery. Cont Lens Anterior Eye 2020; 43:589-594. [PMID: 32456950 DOI: 10.1016/j.clae.2020.04.009] [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: 11/25/2019] [Revised: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the use of corneoscleral lenses (CSL) in keratoconus patients who were unsatisfied with their visual outcomes after keratoplasty surgery. METHODS Eleven consecutive cases with unsatisfactory vision with spectacles, due to irregular astigmatism, preferred to try CSL before SL due to handling or economic issues. An eye examination included refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count (ECC) and evaluation of corneal biomechanical parameters (corneal resistance factor, CRF; corneal hysteresis, CH; corneal-compensated intraocular pressure, IOPcc). The fitting process was performed using a diagnostic fitting set. Subjective visual quality and comfort, and CSL usage time were also recorded. Patients were monitored for 1 year. RESULTS Two patients presented intolerance to CSL. Therefore, nine patients (6 males and 3 females; the mean±SD age, 44.56 ± 17.33 years, range 27-82) were fitted with CSL. The log MAR visual acuity of these eyes improved significantly with CSL in relation to the best spectacle-corrected vision (0.02 ± 0.06 vs 0.22 ± 0.15, respectively; p = 0.007). Patients reported prolonged usage times (an average of 9.78 ± 1.99 h; range, 8-14). No significant adverse ocular effects or clinically relevant changes in ocular parameters (ECC, CH, IOPcc, central corneal thickness and keratometry; all p > 0.05), visual quality, comfort rating or usage time were found during the 1-year follow-up. CONCLUSION Corneoscleral lenses could be fitted in non-severe cases after keratoplasty surgery with optimal visual results as they can be a safe and healthy alternative option.
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Affiliation(s)
- Juan Carlos Montalt
- Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain
| | - Esteban Porcar
- Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain.
| | - Enrique España-Gregori
- Department of Surgery, Ophthalmology unit, la Fe University and Polytechnic Hospital, Faculty of Medicine and Odontology, University of Valencia, Hospital la Fe, Valencia 46026, Spain
| | - Cristina Peris-Martínez
- FISABIO Oftalmología Médica and Aviñó&Peris Eye Clinic. Faculty of Medicine and Odontology, University of Valencia, Valencia 46026, Spain
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21
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Impact of Corneoscleral Contact Lens Usage on Corneal Biomechanical Parameters in Keratoconic Eyes. Eye Contact Lens 2019; 45:318-323. [DOI: 10.1097/icl.0000000000000579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Long-term effect of corneoscleral contact lenses on refractory ocular surface diseases. Cont Lens Anterior Eye 2019; 42:399-405. [DOI: 10.1016/j.clae.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
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Jinabhai AN. Customised aberration-controlling corrections for keratoconic patients using contact lenses. Clin Exp Optom 2019; 103:31-43. [PMID: 31264266 DOI: 10.1111/cxo.12937] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
Technological advancements in the design of soft and scleral contact lenses have led to the development of customised, aberration-controlling corrections for patients with keratoconus. As the number of contact lens manufacturers producing wavefront-guided corrections continues to expand, clinical interest in this customisable technology is also increasing among both patients and practitioners. This review outlines key issues surrounding the measurement of ocular aberrations for patients with keratoconus, with a particular focus on the possible factors affecting the repeatability of Hartmann-Shack aberrometry measurements. This review also discusses and compares the relative successes of studies investigating the design and fitting of soft and scleral customised contact lenses for patients with keratoconus. A series of key limitations that should be considered before designing customised contact lens corrections is also described. Despite the challenges of producing and fitting customised lenses, improvements in visual performance and comfortable wearing times, as provided by these lenses, could help to reduce the rate of keratoplasty in keratoconic patients, thereby significantly reducing clinical issues related to corneal graft surgery. Furthermore, enhancements in optical correction, provided by customised lenses, could lead to increased independence, particularly among young adult keratoconic patients, therefore leading to improvements in quality of life.
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Affiliation(s)
- Amit Navin Jinabhai
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Anterior Corneal Curvature and Aberration Changes After Scleral Lens Wear in Keratoconus Patients With and Without Ring Segments. Eye Contact Lens 2019; 45:141-148. [PMID: 30005055 DOI: 10.1097/icl.0000000000000534] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate changes in the anterior corneal curvature and aberrometry after scleral contact lens wear in keratoconus (KC) subjects with and without intracorneal ring segments (ICRS). METHODS Twenty-six subjects diagnosed with keratoconus were selected to participate in the study. Subjects were divided into 2 groups, those with ICRS (KC-ICRS group) and those without ICRS (KC group). Subjects were instructed to wear 16.5-mm scleral lenses for 8 hours. Topographic and aberrometric parameters were evaluated before lens wear and immediately after lens removal. Anterior corneal curvature was evaluated at corneal diameters of 2, 4, 6, and 8 mm, and corneal aberrations were measured at 4-, 6-, and 8-mm pupil diameters. RESULTS The mean age of subjects was 36.95±8.95 years. In KC group, there was a statistically significant flattening of the central corneal curvature, from 6.98 to 7.09 mm (P<0.05). No changes were found in the central corneal curvature in the KC-ICRS group. The KC group showed anterior corneal curvature flattening, mainly in the nasal quadrant. The KC-ICRS group showed flattening primarily in the inferior hemisphere. In the KC group, spherical aberration for 6-mm pupil increased significantly. In the KC-ICRS group, changes in aberrations were significant for high-order root mean square at 4- and 6-mm pupil diameters (P<0.05), for oblique astigmatism for 4 mm and 6 mm, and for vertical coma for 4-mm pupil (P<0.05). CONCLUSION Short-term scleral lens wear showed flattening of the anterior corneal surface in all subjects. In the KC group, the flattening was more pronounced in the nasal quadrant while changes were more pronounced inferiorly in KC-ICRS group.
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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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