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Qiu SX, Fadel D, Hui A. Scleral Lenses for Managing Dry Eye Disease in the Absence of Corneal Irregularities: What Is the Current Evidence? J Clin Med 2024; 13:3838. [PMID: 38999403 PMCID: PMC11242693 DOI: 10.3390/jcm13133838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations.
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Affiliation(s)
- Sharon X Qiu
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Daddi Fadel
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alex Hui
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Macedo-de-Araújo RJ, Amorim-de-Sousa A, González-Méijome JM. Influence of midday removal and re-application of a scleral lens on fluid reservoir thickness, pre-lens tear film quality and visual acuity. Cont Lens Anterior Eye 2024:102250. [PMID: 38897843 DOI: 10.1016/j.clae.2024.102250] [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: 01/05/2024] [Revised: 05/13/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To investigate whether the midday removal and re-application of scleral lenses (SL) influences fluid reservoir (FR) thickness, pre-lens tear film quality and visual acuity. METHODS Two clinical experiments were conducted. A total of 49 keratoconic eyes were evaluated for Part1(tear film and visual acuity analysis) and 12 keratoconic eyes for Part2 (FR thickness analysis). All subjects were wearing 16.4 mm SL for more than 12-months. Tear Film Surface Quality (TFSQ) was evaluated with Medmont E300 at more than 120 min of SL wear, 10 min after SL removal (pre-corneal TFSQ) and 5 min after re-apply the same SL. High and Low Contrast Visual Acuity (HCVA and LCVA) were also assessed with the SL on eye (before and after re-application). For Part2, Anterior OCT (MOptim MOcean4000, China) measurements were taken with and without the SL (at the same time points of Part1) and three outcomes were evaluated: FR thickness, SL thickness (control measurement) and corneal thickness. RESULTS Removing and re-applying a SL had a statistically significant positive impact on TFSQ, with an improvement from 0.26 ± 011 to 0.16 ± 0.08 (p = 0.001). This was accompanied by a statistically significant improvement in LogMAR HCVA (from 0.10 ± 0.09 to 0.08 ± 0.08, p < 0.001) and LCVA (from 0.39 ± 0.13 to 0.36 ± 0.13, p < 0.001). Regarding Part2 of the study, a statistically significant increase in FR thickness was observed after SL re-application (from 223.64 ± 48.08 µm to 267.81 ± 80.03 µm, p = 0.007). No changes in corneal thickness were observed. CONCLUSIONS Midday removal and re-application of a scleral lens positively impacted pre-lens tear film surface quality, although the observed improvement in visual acuity does not constitute a clinically significant change. Clinicians should consider that removing and reapplying a scleral lens may result in an overestimation of the fluid reservoir thickness, which could affect clinical assessments and treatment decisions.
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Affiliation(s)
- Rute J Macedo-de-Araújo
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal.
| | - Ana Amorim-de-Sousa
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal
| | - José M González-Méijome
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal
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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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Tang X, Liu J, Yan R, Peng Q. Carbohydrate polymer-based bioadhesive formulations and their potentials for the treatment of ocular diseases: A review. Int J Biol Macromol 2023; 242:124902. [PMID: 37210054 DOI: 10.1016/j.ijbiomac.2023.124902] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Eyes are directly exposed to the outer environment and susceptible to infections, leading to various ocular disorders. Local medication is preferred to treat eye diseases due to its convenience and compliance. However, the rapid clearance of the local formulations highly limits the therapeutic efficacy. In the past decades, several carbohydrate bioadhesive polymers (CBPs), such as chitosan and hyaluronic acid, have been used in ophthalmology for sustained ocular drug delivery. These CBP-based delivery systems have improved the treatment of ocular diseases to a large extent but also caused some undesired effects. Herein, we aim to summarize the applications of some typical CBPs (including chitosan, hyaluronic acid, cellulose, cyclodextrin, alginate and pectin) in treating ocular diseases from the general view of ocular physiology, pathophysiology and drug delivery, and to provide a comprehensive understanding of the design of the CBP-based formulations for ocular use. The patents and clinical trials of CBPs for ocular management are also discussed. In addition, a discussion on the concerns of CBPs in clinical use and the possible solutions is presented.
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Affiliation(s)
- Xuelin Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhong Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ruijiao Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Schornack MM, Nau CB, Harthan J, Shorter E, Nau A, Fogt J. Current Trends in Scleral Lens Prescription, Management, and Evaluation. Eye Contact Lens 2023; 49:56-62. [PMID: 36694309 PMCID: PMC9881749 DOI: 10.1097/icl.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Muriel M Schornack
- Department of Ophthalmology (M.M.S. and C.B.N.), Mayo Clinic, Rochester, MN; Illinois College of Optometry (J.H.), Chicago, IL; Department of Ophthalmology and Visual Sciences (E.S.), University of Illinois at Chicago, Chicago, IL; Korb and Associates (A.N.), Boston, MA; and College of Optometry, The Ohio State University (J.F.), Columbus, OH
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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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Han X, Zhao X, Zeng T, Yang Y, Yu H, Zhang C, Wang B, Liu X, Zhang T, Sun J, Li X, Zhao T, Zhang M, Ni Y, Tong Y, Tang Q, Liu Y. Multimodal-Synergistic-Modulation Neuromorphic Imaging Systems for Simulating Dry Eye Imaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2206181. [PMID: 36504477 DOI: 10.1002/smll.202206181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Inspired by human eyes, the neuromorphic visual system employs a highly efficient imaging and recognition process, which offers tremendous advantages in image acquisition, data pre-processing, and dynamic storage. However, it is still an enormous challenge to simultaneously simulate the structure, function, and environmental adaptive behavior of the human eye based on one device. Here, a multimodal-synergistic-modulation neuromorphic imaging system based on ultraflexible synaptic transistors is successfully presented and firstly simulates the dry eye imaging behavior at the device level. Moreover, important functions of the human visual system in relation to optoelectronic synaptic plasticity, image erasure and enhancement, real-time preprocessing, and dynamic storage are simulated by versatile devices. This work not only simplifies the complexity of traditional neuromorphic visual systems, but also plays a positive role in the publicity of biomedical eye care.
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Affiliation(s)
- Xu Han
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Xiaoli Zhao
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Tao Zeng
- Department of Materials Science and Engineering, National University of Singapore, Singapore, 117575, Singapore
| | - Yahan Yang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Hongyan Yu
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Cong Zhang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Bin Wang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Xiaoqian Liu
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Tao Zhang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Jing Sun
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Xinyuan Li
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Tuo Zhao
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Mingxin Zhang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Yanping Ni
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Yanhong Tong
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Qingxin Tang
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
| | - Yichun Liu
- Center for Advanced Optoelectronic Functional Materials Research, and Key Lab of UV-Emitting Materials and Technology of Ministry of Education, Northeast Normal University, 5268 Renmin Street, Changchun, 130024, China
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