ANALYSIS OF CONJUNCTIVAL VASCULAR DENSITY IN SCLERAL CONTACT LENS WEARERS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

Conjunctival microvascular alteration in patients with coronary artery disease assessed using optical coherence tomographic angiography

BACKGROUND

To quantify conjunctival microvascular characteristics obtained by optical coherence tomographic angiography (OCTA) and investigate their relationship with the presence and severity of coronary artery disease (CAD).

METHODS

This cross-sectional study included 103 consecutive CAD patients confirmed by coronary angiography and 125 non-CAD controls. The temporal conjunctivas along the limbus of each participant were scanned using OCTA. Quantification of conjunctival microvasculature was performed by AngioTool software. The severity of the disease was evaluated using SYNTAX and Gensini scores.

RESULTS

Compared to the controls, the CAD group exhibited significantly lower vessel area density (30.22 ± 3.34 vs. 26.70 ± 4.43 %, p < 0.001), lower vessel length density (6.39 ± 0.77 vs. 5.71 ± 0.89/m, p < 0.001), lower junction density (3.44 ± 0.56 vs. 3.05 ± 0.63/m, p < 0.001), and higher lacunarity (0.11 ± 0.03 vs. 0.14 ± 0.05, p < 0.001). Among all participants, lower vessel area density, lower vessel length density, lower junction density, and higher lacunarity were associated with greater odds of having CAD; the adjusted ORs (95 % confidence intervals) per one SD decrease were 2.71 (1.71, 4.29), 2.51(1.61, 3.90), 2.06 (1.39, 3.05), and 0.36 (0.23, 0.58), respectively. Among CAD patients, junction density was negatively associated with the Gensini score (r = -0.359, p = 0.037) and the Syntax score (r = -0.350, p = 0.042) in women but not in men (p > 0.05).

CONCLUSIONS

Conjunctival microvascular characteristics were significantly associated with the presence of CAD. Junction density significantly associated with the severity of CAD among women patients.

The effect of extended periods of mini-scleral lens wear on the conjunctival/episcleral and scleral thickness

PURPOSE

To evaluate the conjunctival/episcleral thickness (CET) and anterior scleral thickness (AST) in patients with keratoconus with an extended duration of mini-scleral contact lens wear by utilizing anterior segment optical coherence tomography (ASOCT).

METHODS

This study included 17 eyes of 17 patients with keratoconus with mini-scleral contact lens wear (Group 1), 20 eyes of 20 patients with keratoconus without any contact lens wear (Group 2), and 20 eyes of 20 healthy controls (Group 3). CET and AST were measured using AS-OCT (Triton, Topcon, Japan) at 1, 2, and 3 mm posterior to the scleral spur in the nasal, temporal, superior, and inferior quadrants.

RESULTS

The median age of the mini-scleral contact lens group was 26, and the number of male patients was 14 (82.4 %). The superior CET values at 1 mm, 2 mm, and 3 mm statistically differed between the groups, with Group 1 having significantly lower values than Group 3 and Group 2 having statistically similar values to the remaining two groups. The inferior CET at 2 mm was lower in Groups 1 and 2 than in Group 3. The inferior CET at 3 mm was lower in Group 1 compared to Groups 2 and 3. AST was similar between the groups at all measured quadrants and distances. The duration of lens wear had a strong, statistically significant, negative correlation with the superior CET at 2 mm (rho: -0.847, p < 0.001) and a moderate, statistically significant, negative correlation with the superior CET at 3 mm (rho: -0.506, p < 0.038).

CONCLUSIONS

In this study, it was found that mini-scleral contact lens usage causes thinning in the conjunctival-episcleral layer, especially in the superior and inferior quadrants, but does not affect scleral thickness. AS-OCT is a non-invasive and clinically applicable technique for assessing the impact of contact lens use on the conjunctiva/episclera and sclera.

Current clinical applications of anterior segment optical coherence tomography angiography: a review

Optical coherence tomography (OCT) is a revolutionary in vivo imaging technology that presents real-time information on ocular structures. Angiography based on OCT, known as optical coherence tomography angiography (OCTA), is a noninvasive and time-saving technique originally utilized for visualizing retinal vasculature. As devices and built-in systems have evolved, high-resolution images with depth-resolved analysis have assisted ophthalmologists in accurately localizing pathology and monitoring disease progression. With the aforementioned advantages, application of OCTA has extended from the posterior to anterior segment. This nascent adaptation showed good delineation of the vasculature in the cornea, conjunctiva, sclera, and iris. Thus, neovascularization of the avascular cornea and hyperemia or ischemic changes involving the conjunctiva, sclera, and iris has become prospective applications for AS-OCTA. Although traditional dye-based angiography is regarded as the gold standard in demonstrating vasculature in the anterior segment, AS-OCTA is expected to be a comparable but more patient-friendly alternative. In its initial stage, AS-OCTA has exhibited great potential in pathology diagnosis, therapeutic evaluation, presurgical planning, and prognosis assessments in anterior segment disorders. In this review of AS-OCTA, we aim to summarize scanning protocols, relevant parameters, and clinical applications as well as limitations and future directions. We are sanguine about its wide application in the future with the development of technology and refinement in built-in systems.

Current Trends in Scleral Lens Prescription, Management, and Evaluation

OBJECTIVES

To report current trends in scleral contact lens prescription and management, including lens designs prescribed, care products recommended, and procedures performed during routine scleral lens (SL) evaluation.

METHODS

An online survey was designed by the Scleral Lenses in Current Ophthalmic Practice Evaluation study team and administered to eye care practitioners attending a specialty contact lens meeting. The survey was available from November 8, 2019, through March 31, 2020. Participants' demographic data were collected, along with information on lens diameters, landing zone (LZ) designs, recommended care products, and components of routine SL evaluation.

RESULTS

In total, 715 participants responded to at least one of the survey items of interest. Most lenses prescribed (63%) were 16 mm or more in diameter. Lenses with toric LZs were the most frequently prescribed (48%), followed by spherical (40%), quadrant-specific (8%), and impression-based or image-based designs (3%). Most participants (61%) recommended hydrogen peroxide products for lens care. Nonpreserved saline in a single-use vial was most frequently recommended to fill the bowl of the lens before application. Intraocular pressure was measured during SL evaluation by 45% of participants; 38% of participants routinely measured corneal thickness.

CONCLUSIONS

Practitioners increasingly are prescribing SLs with advanced LZ designs. Most practitioners recommend hydrogen peroxide-based disinfection systems and single-use vials of nonpreserved saline for lens care and application. Because differences in components of routine SL evaluations were reported, clinicians may benefit from reaching a consensus on essential components of SL evaluation.

How Can We Best Measure the Performance of Scleral Lenses? Current Insights

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.

Advances and Current Clinical Applications of Anterior Segment Optical Coherence Tomography Angiography

Optical coherence tomography angiography (OCTA) is the most relevant evolution based on optical coherence tomography (OCT). OCTA can present ocular vasculature, show detailed morphology for assessment, and quantify vessel parameters without intravenous dye agent. Research on the anterior segment OCTA (AS-OCTA) is only in its initial phase, and its advances in clinical diagnosis and treatment efficacy evaluations require a detailed comparison to traditional imaging methods. In this review of AS-OCTA, we summarize its technical features, imaging advances, current clinical applications in various eye diseases, as well as its limitations and potential future directions. AS-OCTA offers potential advantages in ophthalmic imaging, and with further development it could become a common tool in the near future.