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García-Marqués JV, Macedo-De-Araújo RJ, Cerviño A, García-Lázaro S, González-Méijome JM. Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study. Cont Lens Anterior Eye 2023; 46:101571. [PMID: 34996711 DOI: 10.1016/j.clae.2021.101571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To validate a previously developed algorithm based on the visibility of meibomian gland images obtained with Cobra fundus camera and to assess the changes in meibomian glands in scleral lens wearers over one year of lens wear. METHODS Infrared meibography was obtained from the upper eyelid using the Cobra fundus camera in forty-three volunteers (34.2 ± 10.1 years). Meibographies were classified into 3 groups: Group 1 = good subjective gland visibility and gland drop-out < 1/3 of the total area; Group 2 = low visibility and gland drop-out < 1/3; and Group 3 = low visibility and gland drop-out > 1/3. Meibomian gland visibility metrics were then calculated using the developed algorithm from the pixel intensity values of meibographies. Repeatability of new metrics and their correlations with gland drop-out were assessed. Meibographies and ocular symptoms were also assessed after 1 year of scleral lens wear in 29 subjects. RESULTS Gland drop-out percentage was not statistically different between groups 1 and 2 (p = 0.464). Nevertheless, group 1 showed higher grey pixel intensity values than the other groups. Statistically significant correlations were found between gland visibility metrics and gland drop-out percentage. Repeatability was acceptable for all metrics, coefficient of variation achieving values between 0.52 and 3.18. While ocular symptoms decreased with scleral lens wear (p < 0.001), no statistically significant differences were found in gland drop-out percentage (p = 0.157) and gland visibility metrics (p > 0.217). CONCLUSIONS The proposed method can assess meibomian gland visibility in an objective and repeatable way. Scleral lens wear appears to not adversely affect meibomian gland drop-out and visibility while might improve dry eye symptoms after one year of lens wear. These preliminary results should be confirmed with a control group.
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Affiliation(s)
| | - Rute Juliana Macedo-De-Araújo
- Clinical and Experimental Optometry Research Laboratory (CEORLab) Center of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal
| | - Alejandro Cerviño
- Department of Optics and Optometry and Vision Sciences. University of Valencia, Burjassot, Spain
| | - Santiago García-Lázaro
- Department of Optics and Optometry and Vision Sciences. University of Valencia, Burjassot, Spain
| | - Jose Manuel González-Méijome
- Clinical and Experimental Optometry Research Laboratory (CEORLab) Center of Physics (Optometry), School of Sciences, University of Minho, Braga, Portugal
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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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Metzger M, Navel V, Barrière JV, Kwiatkowski F, Hébraud J, Mulliez A, Béral L, Chiambaretta F, Dutheil F. Benefits of using corneal topography to choose subjective refraction technique in keratoconus (RE-CON): a prospective comparative crossover clinical study. Graefes Arch Clin Exp Ophthalmol 2021; 260:197-207. [PMID: 34415365 DOI: 10.1007/s00417-021-05382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In prospective no-masking, comparative, crossover monocenter clinical trial, we aimed to evaluate whether the optimal subjective refraction technique varies with the keratoconus topography and to identify relevant topographic criteria. METHOD This study included 72 keratoconus eyes with impaired visual acuity. Each eye tested three methods of refraction (Jackson cylinder, astigmatism dial, stenopeic slit), resulting in three eyeglass lenses. Patients were assigned to the group corresponding to the eyeglass lens offering the best visual acuity. Five topographical characteristics were collected via the Pentacam: mean keratometry (Km), maximum keratometry (Kmax), distance from corneal center to Kmax (dKmax), Belin/Ambrosio Display (BAD_D), and index of surface variance (ISV). RESULTS Forty-six eyes were included in the dial group (64.8%), 23 eyes in the cylinder group (32.4%), and only 2 eyes in the slit group (2.8%); thus, we only compared dial and cylinder groups. The main analysis retrieved a significant probability to choose dial technic for BAD_D (p = 0.024); when BAD_D is > 9.71 (ROC threshold), the positive predictive value (PPV) = 89.5%, and for ISV, p = 0.012; when ISV is > 77, PPV = 89.1%. The sub-analysis of patients with different visual acuities between cylinder and dial confirmed these results with slightly different thresholds: the probability to choose dial technic was for BAD_D, p = 0.03; when BAD_D is > 7.55, PPV = 90%, and for ISV, p = 0.0084; when ISV is > 71, PPV = 88.5%. CONCLUSION Refraction method is linked to topographic indices ISV and BAD_D. A BAD_D > 7.55 indicates the dial method. In addition to keratoconus screening and diagnosis, this study suggests a new application of the topographer to select a suitable refraction method for eyeglass prescription. TRIAL REGISTRATION Study registered on the ClinicalTrials.gov database under n°: NCT04174209.
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Affiliation(s)
- Margaux Metzger
- CHU, Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France.
| | - Valentin Navel
- Université Clermont Auvergne, CNRS, INSERM, GReD, Translational Approach To Epithelial Injury and Repair, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, 63000, Ophthalmology, France.
| | - Jean-Vincent Barrière
- CHU, Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | - Fabrice Kwiatkowski
- Laboratory of Mathematics, Université Clermont Auvergne, Blaise Pascal, Clermont-Ferrand, France
| | - Jérémy Hébraud
- Intensive Care Unit, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France
| | - Laurence Béral
- CHU Pointe-À-Pitre Abymes, University Hospital of Pointe-À-Pitre Abymes, Ophthalmology, Pointe-à-Pitre, France
| | - Frédéric Chiambaretta
- Université Clermont Auvergne, CNRS, INSERM, GReD, Translational Approach To Epithelial Injury and Repair, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, 63000, Ophthalmology, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
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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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Rocha G, Vieira BV, Mendes BMS, Iguma CI, Silva TCS, de Sousa LB, Tzelikis PF. Visual outcomes in advanced keratoconus using different strategies: Scleral lens, intracorneal ring segment and lamellar keratoplasty. Eur J Ophthalmol 2021; 31:1563-1570. [PMID: 33583232 DOI: 10.1177/1120672121994731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare VA outcomes in patients with advanced keratoconus wearing SCL or after ICRS or DALK. In addition, determine the percentage of complimentary treatments after ICRS and DALK, and which of these was fitting a SCL, and final visual acuity (f-VA) results. METHODS Retrospective case series analyzed 55 eyes with advanced keratoconus fitted with SCL, or after ICRS or a DALK between 2010 and 2018. The variables analyzed were sex, age, UDVA, CDVA, SEQ, K-readings, and f-VA after complimentary treatments. RESULTS Twenty-eight eyes underwent a DALK, 14 were fitted with a SCL, and other 13 underwent ICRS insertion. Patients after DALK and after ICRS showed statistically significant improvement in UDVA and CDVA after surgery, with no difference between these groups. Patients fitted with SCL showed statistically higher CDVA improvement when compared to ICRS. After DALK and ICRS, respectively, nine eyes (32.14%) and seven eyes (53.85%) were fitted with SCL. Comparison between f-VA with SCL in three groups showed that the best result was achieved in DALK + SCL, with statistically significant difference to only SCL. CONCLUSION We showed that the CDVA of eyes fitted with SCL without any surgical treatment was statistically better than CDVA of eyes after ICRS insertion. After DALK and ICRS insertion, many patients needed a complimentary treatment to improve CDVA. The most chosen treatment was fitting a SCL. After this, all eyes showed statistically significant improvement in f-VA, with statistically better results for DALK + SCL when compared to SCL fitted in advanced keratoconus without any surgical treatment.
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Affiliation(s)
- Guilherme Rocha
- Contact Lens Sector, Refractive Surgery and Cornea Sector, Hospital Oftalmológico de Brasília, Brasilia, Brazil
| | | | | | | | | | | | - Patrick Frensel Tzelikis
- Cornea Sector and Refractive Surgery Sector, Hospital Oftalmológico de Brasília, Brasilia, Brazil
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Lim L, Lim EWL. Current perspectives in the management of keratoconus with contact lenses. Eye (Lond) 2020; 34:2175-2196. [PMID: 32641797 PMCID: PMC7784906 DOI: 10.1038/s41433-020-1065-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/30/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Our aim is to review current and significant articles on contact lens wear in keratoconus patients. A comprehensive literature search of PubMed was performed for the following topics on contact lens wear in keratoconus patients: (1) characteristics of contact lens wearers, (2) safety and efficacy, (3) complications, (4) fitting techniques, (5) contact lens wear after procedures/surgeries, (6) patient satisfaction. A total of 104 studies were finally selected and reviewed. Gas permeable (GP) lens wear provided significantly better vision than glasses. Special cone design lenses had better patient comfort levels though there was no difference in best corrected visual acuity among the GP lenses. Soft lenses showed good efficacy for the treatment of mild-to-moderate keratoconus with newer designs improving visual performance such as customised hydrogel and novel pinhole lenses. Scleral and hybrid lenses provide good visual acuity and comfort for keratoconic patients previously intolerant to RGP lenses. RGP lens wear post-cross linking (CXL) is relatively well-tolerated. Contact lenses may still be required post intrastromal corneal ring procedures and post keratoplasty. Scheimpflug imaging and anterior segment optical coherent tomography (ASOCT) are useful in contact lens fitting. Computerized contact lens fitting techniques could reduce the chair time of lens fitting as well as improve comfort and visual performance. Contact lenses play an important role in the visual rehabilitation of keratoconus patients. New contact lens designs and materials have significantly expanded the available fitting options for keratoconus patients. Imaging technology can be utilized to guide contact lens fitting.
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Affiliation(s)
- Li Lim
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, 20 College Road Discovery Tower Level 6, The Academia, Singapore, 169856, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Elizabeth Wen Ling Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
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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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Abstract
PURPOSE OF REVIEW To review the efficacy of intrastromal corneal ring segments (ICRS) for keratoconus and with other interventions such as contacts lens, keratoplasty, and corneal collagen cross-linking. RECENT FINDINGS Changes in ICRS thickness and size, combination of procedures, and the adaptation of a more sophisticated classification system have broadened our application of ICRS. Recent studies have shown the long-term efficacy of ICRS in visual acuity, keratometry, and astigmatism. SUMMARY Studies have demonstrated the short-term and long-term efficacy of ICRS implantation in patients with keratoconus.
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