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Shorter E, Fogt J, Nau C, Harthan J, Nau A, Schornack M. Image- and impression-based technology for scleral lens fitting for keratoconus: Efficiency of the fitting process. Cont Lens Anterior Eye 2024; 47:102174. [PMID: 38693011 DOI: 10.1016/j.clae.2024.102174] [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: 09/22/2023] [Revised: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE This study describes efficiency of diagnostic, image-based, and impression-based fitting methods by eye care providers who prescribe scleral lenses (SL) for patients with keratoconus. METHODS An electronic survey was distributed to eye care providers with an interest in SL fitting. Demographic data including practice modality, country of residence, and fitting volume were collected. Efficiency of each fitting method (diagnostic, image, and impression-guided) was queried including time required for initial evaluation, number of lenses ordered, and number of office visits required. Practitioners with access to image and impression-based technology were also asked time required to acquire data and to estimate the percentage of time a lens could be manufactured from the initial images or impressions. RESULTS 423 practitioners who prescribe SL for patients with keratoconus reported completing a median [IQR] 100 [280] SL fittings. There was no difference in the median time required for initial evaluation (30 min; p = 0.5) or median number of lenses ordered during the fitting process (2 lenses; p = 0.2) between diagnostic, image-based, or impression-based SL fitting methods. Median time to acquire initial images was 10 [7] minutes and 15 [10] minutes to obtain impressions. Images obtained were adequate to order an initial lens 80 [45]% of the time while initial impressions were adequate 90 [40]%. CONCLUSION In this study, practitioner-reported efficiency of SL fitting was similar between diagnostic, image-based and impression-based methods for patients with keratoconus.
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Affiliation(s)
- Ellen Shorter
- University of Illinois at Chicago, 1855 W Taylor St., Chicago IL, USA.
| | - Jennifer Fogt
- The Ohio State University, 338 West 10th Avenue, Columbus, OH, USA.
| | - Cherie Nau
- Mayo Clinic, Rochester, 200 1(st) St SW, MN, USA.
| | - Jennifer Harthan
- The Illinois College of Optometry, 3241 S Michigan Ave, Chicago, IL, USA.
| | - Amy Nau
- Korb and Associates, 400 Commonwealth Ave, Boston, MA, USA.
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Chaudhary S, Kate A, Basu S, Shanbhag SS. Impact of Symblepharon Management With Ocular Surface Reconstruction on Scleral Lens Fitting in Eyes With Chronic Cicatrizing Conjunctivitis and Keratopathy. Cornea 2024; 43:975-981. [PMID: 38015987 DOI: 10.1097/ico.0000000000003437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/29/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The aim of this study was to describe the importance of symblepharon release with ocular surface reconstruction (OSR) for optimal fitting of scleral contact lenses (SCLs) in eyes with chronic cicatrizing conjunctivitis (CCC) and keratopathy. METHODS This retrospective study included 32 eyes with CCC and keratopathy with symblepharon which underwent symblepharon release with OSR and were fitted with SCLs. The primary outcome measure was the improvement in best-corrected visual acuity with SCL wear. RESULTS A total of 32 eyes of 29 patients (66% men) with a median age of 30.5 years were included. The common causes of CCC were Stevens-Johnson syndrome (66%) and ocular burns (16%). The most common location of symblepharon was superior (59%) with limbal involvement in most eyes (94%). Symblepharon release was combined with mucous membrane grafting (63%), amniotic membrane grafting (31%), or conjunctival autografting (6%). The median interval between symblepharon release with OSR and SCL trial was 15 weeks [interquartile range (IQR): 6-24]. The median best-corrected visual acuity improved from logMAR 1.5 (IQR: 1.2-1.8) to logMAR 1.2 (IQR: 0.6-1.4) with SCLs after symblepharon release with OSR ( P < 0.001). The median diameter of the SCL used was 15 mm (IQR: 15-16), with a median base curve of 7.9 mm (IQR: 7.9-8). Symblepharon recurrence was noted in 70% of eyes that underwent amniotic membrane grafting; no recurrence was seen with mucous membrane grafting or conjunctival autografting. CONCLUSIONS In eyes with CCC with keratopathy and symblepharon, visual rehabilitation is possible with SCLs after symblepharon release with OSR without having to resort to a penetrating corneal procedure.
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Affiliation(s)
- Simmy Chaudhary
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Bausch & Lomb Contact Lens Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anahita Kate
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; and
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Fogt JS, Schornack M, Nau C, Harthan J, Nau A, Shorter E. Image- and Impression-Based Technology in Scleral Lens Fitting for Keratoconus: Availability and Utilization. Eye Contact Lens 2024; 50:292-296. [PMID: 39078501 PMCID: PMC11296498 DOI: 10.1097/icl.0000000000001100] [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: 09/21/2023] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Scleral lenses (SLs) can be customized using traditional diagnostic lens fitting or by using image- and/or impression-based technologies. This study describes the availability and usage of SL fitting technology in patients with keratoconus. METHODS An online survey queried practitioners on the mode of practice, country of residence, and estimated number of SL fits completed for keratoconus. Practitioners were asked whether they had access to image- and/or impression-based technology and to estimate the percentage of fits completed using diagnostic fitting, image-based technology, and impression-based technology. Access and usage of technology was compared between academic and community practices, United States and non-United States, and high-volume (≥60 SLs) and low-volume fitters. RESULTS 423 practitioners who fit SL for keratoconus participated. Image- and impression-based technologies were more frequently available in academic practices compared with community practices and high-volume compared with low-volume practitioners ( P <0.005). Practitioners with image-based technology used it for a median [interquartile range] 5 [25]% of SL fittings; those with impression-based technology used it for 8 [9]% of fittings, and those with both types of technology used image-based devices for 12 [23]% of fittings and impression-based for 5 [8]% of fittings. CONCLUSIONS In this study, most participants report using diagnostic lenses to fit SLs for patients with keratoconus.
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Affiliation(s)
- Jennifer Swingle Fogt
- The Ohio State University (J.S.F.), 338 West 10th Avenue, Columbus, OH, USA; Mayo Clinic, Rochester, 200 1 St SW, MN, USA; The Illinois College of Optometry, 3241 S Michigan Ave, Chicago, IL, USA; Korb and Associates, 400 Commonwealth Ave, Boston, MA, USA; and University of Illinois at Chicago, 1855 W Taylor St., Chicago IL, USA
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Dash N, Choudhury D. Dry Eye Disease: An Update on Changing Perspectives on Causes, Diagnosis, and Management. Cureus 2024; 16:e59985. [PMID: 38854318 PMCID: PMC11162257 DOI: 10.7759/cureus.59985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it has on the ocular surface after any surface procedure. With changing times, several new factors have come to light that can influence this disease. The effect of the COVID-19 pandemic has also been greatly felt, with a range of causes, starting from increased screen work to inflammatory processes, exacerbating the condition in many. With changes in the concepts of the etiopathogenesis of the disease, a paradigm shift has taken place in the approaches to treatment. More researchers are in favor of a new tear film-oriented approach that tries to localize the disease to a single component in the tear film. Innovation of newer techniques for the treatment of meibomian gland disease has also made its foray into clinical ophthalmology. Newer drug formulations and molecules are underway to better treat the inflammatory component of the disease. Many other receptors and targets for the treatment of dry eyes are being researched. This review hopes to provide a succinct, narrative summary of the relevant research on dry eye disease to date to increase awareness about the nature and future course of this disease and its management.
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Affiliation(s)
- Nikita Dash
- Ophthalmology, Sir Ganga Ram Hospital, New Delhi, IND
| | - Deepak Choudhury
- Ophthalmology, Maharaja Krishna Chandra Gajapati (MKCG) Medical College, Berhampur, IND
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Yoon H, Harthan JS, Skoog W, Fogt JS, Nau A, Nau CB, Schornack M, Shorter E. Process and Outcomes of Fitting Corneoscleral Profilometry-Driven Scleral Lenses for Patients With Ocular Surface Disease. Eye Contact Lens 2024; 50:132-137. [PMID: 38305382 PMCID: PMC10922638 DOI: 10.1097/icl.0000000000001064] [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] [Accepted: 10/28/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To assess the feasibility of obtaining cornea scleral profile (CSP) measurements using Scheimpflug imaging and report on the fitting process of free-form custom scleral lenses (SLs) for patients with ocular surface disease (OSD). METHODS This prospective study of patients fit with free-form SLs collected data on the following: demographics, indications for wear, corneal and scleral tomography, scan acquisition process, and SL fitting process. RESULTS Cornea scleral profile scans were acquired on 15 eyes of nine patients. Mean scan time for right eyes was 10.7, and 9.7 min for left eyes. A mean of 2.9 follow-up visits were required to complete SL fitting, with a mean of 2.1 lenses ordered. One eye did not tolerate lens wear, and one eye could not be fit using the CSP scan because of insufficient data. The initial lens ordered was dispensed at the first follow-up visit for seven of the remaining 13 eyes, all of which were ultimately fit successfully in free-form lenses. CONCLUSIONS In this study of profilometry-guided SL fitting for eyes with OSD and low magnitude corneal astigmatism, the number of lenses and follow-up visits required were similar to outcomes of previous studies that described the diagnostic approach to SL fitting. In addition, imaging technology does not negate the need for skilled clinical observation while fitting SLs.
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Affiliation(s)
- Hannah Yoon
- University of Illinois at Chicago, Chicago, Illinois
| | | | | | | | - Amy Nau
- Korb and Associates, Boston, Massachusetts
| | | | | | - Ellen Shorter
- University of Illinois at Chicago, Chicago, Illinois
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Morel M, Severinsky B, Kim HJ, Behshad S. Semiscleral Contact Lens Use After Direct Corneal Neurotization for Neurotrophic Keratopathy. Eye Contact Lens 2023; 49:471-474. [PMID: 37616173 DOI: 10.1097/icl.0000000000001028] [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: 07/19/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To describe a case of a patient treated for neurotrophic keratopathy (NK) with direct corneal neurotization (CN), where a modification to the CN technique allowed for semiscleral contact lens use postoperatively. OBSERVATION Our patient had successful CN with improved corneal sensation. During the procedure, a 1.0 mm gutter was created between the limbus and nerve graft to allow for semiscleral contact lens fitting. CONCLUSIONS With the use of preoperative planning and a limbal gutter during CN, a semiscleral contact lens can serve as a well-tolerated postoperative management option to improve visual acuity and protect the corneal surface in patients with NK.
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Affiliation(s)
- Mark Morel
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
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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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8
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Bonnet C, Lee A, Shibayama VP, Tseng CH, Deng SX. Clinical outcomes and complications of fluid-filled scleral lens devices for the management of limbal stem cell deficiency. Cont Lens Anterior Eye 2023; 46:101528. [PMID: 34728142 PMCID: PMC9054946 DOI: 10.1016/j.clae.2021.101528] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
AIMS To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD). DESIGN Retrospective consecutive case series. METHODS 27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed. RESULTS Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling. CONCLUSION SL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.
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Affiliation(s)
- Clémence Bonnet
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA.,Ophthalmology Department, Paris University, Cochin Hospital, AP-HP, F-75014, Paris, France
| | - Andrew Lee
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Vivian P. Shibayama
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Chi-Hong Tseng
- David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, USA
| | - Sophie X. Deng
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA.,Molecular Biology Institute, University of California, Los Angeles, USA
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Nagai N, Otake H. Novel drug delivery systems for the management of dry eye. Adv Drug Deliv Rev 2022; 191:114582. [PMID: 36283491 DOI: 10.1016/j.addr.2022.114582] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023]
Abstract
Dry eye disease (DED) is a frequently observed eye complaint, which has recently attracted considerable research interest. Conventional therapy for DED involves the use of artificial tear products, cyclosporin, corticosteroids, mucin secretagogues, antibiotics and nonsteroidal anti-inflammatory drugs. In addition, ocular drug delivery systems based on nanotechnology are currently the focus of significant research effort and several nanotherapeutics, such as nanoemulsions, nanosuspensions, microemulsions, liposomes and nanomicelles, are in clinical trials and some have FDA approval as novel treatments for DED. Thus, there has been remarkable progress in the design of nanotechnology-based approaches to overcome the limitations of ophthalmic formulations for the management of anterior eye diseases. This review presents research results on diagnostic methods for DED, current treatment options, and promising pharmaceuticals as future therapeutics, as well as new ocular drug delivery systems.
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Affiliation(s)
- Noriaki Nagai
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan.
| | - Hiroko Otake
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan.
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Tear Exchange, Intraocular Pressure, and Wear Characteristics of Quadrant-specific Versus Spherical Haptic Scleral Lenses. Eye Contact Lens 2022; 48:460-465. [PMID: 35973376 DOI: 10.1097/icl.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare scleral lenses (SLs) with a quadrant-specific (study lens) or a spherical (habitual lens) landing zone in a crossover study. METHODS Seven participants (eight eyes) wore each of two lenses for 2 weeks before measurements. We measured visual acuity, contrast sensitivity, intraocular pressure (IOP), fluid reservoir clearance, corneal thickness, tear exchange, and lens experience. Variables were compared between lenses and before and after 2 hr of wear. RESULTS The visual acuity was not different between the study lens, 0.12 logarithm of the minimum angle of resolution (logMAR), and habitual lens, 0.18 logMAR (median, P = 1.0). Contrast sensitivity was 1.3% under the study lens and 1.6% under the habitual lens ( P = 0.94). IOP did not change after 2 hr of wear for either lens (study lens, P = 0.33 and habitual lens, P = 0.74), and corneal thickness did not change during wear of either lens ( P = 0.44). The fluorescein concentration under the study lens did not change after 2 hr (99% of initial concentration; P = 0.84) but decreased to 46% of initial concentration under the habitual lens ( P = 0.008). Lens comfort was slightly better with the study lens (5.0 vs. 4.0, respectively; P = 0.05). CONCLUSIONS SLs with spherical or quadrant-specific landing zones provide good vision and do not affect IOP or corneal thickness. However, tear exchange is greater under spherical lenses than under quadrant-specific lenses. The quadrant-specific lens provides greater patient comfort.
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Ocular Impression-Based Scleral Lens With Wavefront-Guided Optics for Visual Improvement in Keratoconus. Eye Contact Lens 2022; 48:485-488. [PMID: 35916554 DOI: 10.1097/icl.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT This case reports on the use of wavefront-guided (wfg) optics on custom ocular impression-based scleral lenses (IBSLs) for visual improvement in a patient with keratoconus (KC). A 28-year-old man with KC, who had previously failed a traditional, diagnostically fit scleral lens (tSL), was fit with IBSLs with traditional optics. Using a system that included a dot matrix on the IBSL and a wavefront aberrometer with pupil and dot registration software, a wfgIBSL was created. When compared with the IBSL, the wfgIBSL reduced the total higher-order root mean square (HORMS) 67% and 64% in the right and left eye, respectively, resulting in a 2-line improvement in best-contact lens visual acuity (BCLVA) for both eyes. This case demonstrates the successful creation and application of a wfgIBSL resulting in a stable lens, a reduction in HORMS, and an improvement in BCLVA, after failure with a diagnostically fit tSL.
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12
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Wang Y, Jacobs DS. Role of therapeutic contact lenses in management of corneal disease. Curr Opin Ophthalmol 2022; 33:306-310. [PMID: 35779054 DOI: 10.1097/icu.0000000000000859] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review highlights areas of innovation and research in the use of contact lenses in the treatment of corneal ectasia and ocular surface disease. RECENT FINDINGS A series of academic reports were published by a committee of experts reviewing evidence-based practice patterns of contact lens use. There continues to be active research in the use of contact lenses in the management of keratoconus, including mini-scleral lenses, custom impression-based scleral lenses and wavefront-guided scleral lenses. Recent reports on contact lenses for ocular surface disease were primarily reviews, retrospective case reports or case series, with publications on contact lens use in corneal epithelial defects, graft-vs.-host disease, limbal stem cell deficiency and neurotrophic keratitis. There are recent publications on advances in drug-eluting contact lenses. SUMMARY Corneal specialists should be aware of current advances in the field of contact lens expanding their use in corneal ectasia and ocular surface disease.
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Affiliation(s)
- Yvonne Wang
- Department of Ophthalmology, Yale School of Medicine, New Haven, Connecticut
| | - Deborah S Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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13
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Mohamed HB, Abd El-Hamid BN, Fathalla D, Fouad EA. Current trends in pharmaceutical treatment of Dry Eye Disease: A review. Eur J Pharm Sci 2022; 175:106206. [PMID: 35568107 DOI: 10.1016/j.ejps.2022.106206] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/02/2023]
Abstract
Dry eye disease (DED), keratoconjunctivitis sicca or dysfunctional tear syndrome, is the most prevalent ophthalmic disease which affects a substantial segment of people worldwide with increasing frequency. It is considered a multifactorial disease of the ocular surface and tear film, characterized by a variation of signs and symptoms. The symptoms range from mild to severe itching, burning, irritation, eye fatigue, and ocular inflammation that may lead to potential damage to the cornea, conjunctiva and even vision loss. Correspondingly, depending on the different manifestations and pathophysiology, the treatment must be tailored specifically to each patient by targeting the specific mechanisms implicated in their disease. Currently, there are several medical products and techniques available or under investigation for the treatment of DED. The present article focused on the pathophysiology of DED, the new diagnostic approach and the recently developed drug delivery systems or devices reducing the progress of the disease and treating the causes.
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Affiliation(s)
- Hebatallah B Mohamed
- Department of Pharmaceutics, Faculty of Pharmacy, South Valley University, Qena, 83523, Egypt.
| | - Basma N Abd El-Hamid
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Dina Fathalla
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Ehab A Fouad
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
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14
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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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15
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Patel RP, Samples JS, Riaz KM. Frugal Method of Notch Modification of Scleral Contact Lenses in the Setting of Complex Ocular Surface Anatomy. Eye Contact Lens 2022; 48:88-90. [PMID: 34812771 DOI: 10.1097/icl.0000000000000865] [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: 10/18/2021] [Indexed: 10/19/2022]
Abstract
ABSTRACT Scleral contact lenses (ScCLs) have gained popularity as a treatment of refractive errors in patients with complex anterior segment pathology. Patients with mechanical abnormalities of the ocular surface may be unsuccessful with traditional ScCL fitting. Scleral contact lens modifications, such as notching and microvaulting, typically incur additional financial costs and require the services of professional laboratories. We describe a frugal method of ScCL notch modification that can be performed by a practitioner using readily available tools in a single office visit. Two patients with abnormal ocular surface anatomy were fit with the practitioner-modified ScCL and achieved successful visual rehabilitation. We offer this method as a potentially economical and effective technique to achieve successful ScCL fitting in this challenging patient population with pathologies that may preclude standard ScCL usage.
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Affiliation(s)
- Raj P Patel
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, OK
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16
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Mortensen ZQ, Simmons BA, Shriver EM, Carter KD, Downes SJ. Scleral Contact Lens as Initial Management in a Neonate With a Large Upper Eyelid Coloboma. Ophthalmic Plast Reconstr Surg 2022; 38:e10-e13. [PMID: 34570047 DOI: 10.1097/iop.0000000000002057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A neonate presented with a large full-thickness upper eyelid coloboma with near-complete exposure of the cornea. After failing lubrication and a moisture chamber, he was fit with a customized scleral contact lens that protected the ocular surface. It was tolerated well, and ocular surface health was maintained for 13 months to permit the growth of eyelid tissue for future oculoplastic surgery. Delaying reconstruction by using scleral contact lenses as management for large eyelid colobomas has not been previously described. A temporizing measure such as this could be considered for large eyelid colobomas in neonates.
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Affiliation(s)
- Zachary Q Mortensen
- From the Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
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17
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Álvarez de Toledo Elizalde J, López García S, Benítez Del Castillo JM, Durán de la Colina J, Gris Castejón O, Celis Sánchez J, Herreras Cantalapiedra JM. Aniridia and the ocular surface: Medical and surgical problems and solutions. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96 Suppl 1:15-37. [PMID: 34836585 DOI: 10.1016/j.oftale.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
Congenital aniridia is a multisystemic genetic disease due to a mutation in PAX6 gene which severely affects the development and functionality of the human eyes. In patients affected by the mutation, aside from the absence or defects of iris tissue formation, abnormalities in position or opacities of the crystalline lens, macular hypoplasia, ocular surface disease is the main cause of visual loss and the deterioration of the quality of life of most patients. Limbal stem cell deficiency combined with tear film instability and secondary dry eye cause aniridic keratopathy which, in advanced stages, ends up in corneal opacification. In this paper, the actual knowledge about congenital aniridia keratopathy physiopathology and medical and surgical treatment options and their efficacy are discussed. Indications and results of topical treatments with artificial tears and blood-derivatives in its initial stages, and different surgical techniques as limbal stem cell transplantation, keratoplasty and keratoprostheses are reviewed. Finally, recent advances and results in regenerative medicine techniques with ex vivo stem cell cultivation or other types of cultivated cells are presented.
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Affiliation(s)
| | - S López García
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - J M Benítez Del Castillo
- Cátedra de Oftalmología, Hospital Clínico San Carlos, Universidad Complutense, Clínica Rementería, Madrid, Spain
| | - J Durán de la Colina
- Cátedra de Oftalmología, Universidad del País Vasco, Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Spain
| | - O Gris Castejón
- Departamento de Córnea y Superficie Ocular, Instituto de Microcirugía Ocular de Barcelona (IMO), Barcelona, Spain
| | - J Celis Sánchez
- Unidad de Córnea y Superficie ocular, Hospital La Mancha-Centro, Alcázar de San Juan, Spain
| | - J M Herreras Cantalapiedra
- Instituto Universitario de Oftalmobiología Aplicada (IOBA) de la Universidad de Valladolid, Servicio de Oftalmología del Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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18
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Abstract
PURPOSE In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. METHODS An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. RESULTS A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. CONCLUSIONS This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.
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19
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CLEAR - Contact lens complications. Cont Lens Anterior Eye 2021; 44:330-367. [DOI: 10.1016/j.clae.2021.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
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20
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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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21
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Barnett M, Courey C, Fadel D, Lee K, Michaud L, Montani G, van der Worp E, Vincent SJ, Walker M, Bilkhu P, Morgan PB. CLEAR - Scleral lenses. Cont Lens Anterior Eye 2021; 44:270-288. [PMID: 33775380 DOI: 10.1016/j.clae.2021.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
Abstract
Scleral lenses were the first type of contact lens, developed in the late nineteenth century to restore vision and protect the ocular surface. With the advent of rigid corneal lenses in the middle of the twentieth century and soft lenses in the 1970's, the use of scleral lenses diminished; in recent times there has been a resurgence in their use driven by advances in manufacturing and ocular imaging technology. Scleral lenses are often the only viable form of contact lens wear across a range of clinical indications and can potentially delay the need for corneal surgery. This report provides a brief historical review of scleral lenses and a detailed account of contemporary scleral lens practice including common indications and recommended terminology. Recent research on ocular surface shape is presented, in addition to a comprehensive account of modern scleral lens fitting and on-eye evaluation. A range of optical and physiological challenges associated with scleral lenses are presented, including options for the clinical management of a range of ocular conditions. Future applications which take advantage of the stability of scleral lenses are also discussed. In summary, this report presents evidence-based recommendations to optimise patient outcomes in modern scleral lens practice.
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Affiliation(s)
- Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, United States.
| | | | | | - Karen Lee
- University of Houston, College of Optometry, Houston, TX, United States
| | | | - Giancarlo Montani
- Università del Salento, Dipartimento di Matematica e Fisica CERCA, Lecce, Italy
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, NL, Netherlands
| | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Brisbane, Australia
| | - Maria Walker
- University of Houston, College of Optometry, Houston, TX, United States
| | - Paramdeep Bilkhu
- School of Optometry & Vision Science, Aston University, Birmingham, United Kingdom
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
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Lee SK, Zabrowski C, McClelland CM, Lee MS. Treatment of Horizontal Binocular Diplopia With Prismatic Contact Lenses. J Neuroophthalmol 2021; 41:e81-e82. [PMID: 32235229 DOI: 10.1097/wno.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Samuel K Lee
- Department of Ophthalmology and Visual Neuroscience, University of Minnesota, Minneapolis, Minnesota
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23
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Scleral Lens Use in Neurotrophic Keratopathy: A Review of Current Concepts and Practice. Eye Contact Lens 2021; 47:144-148. [PMID: 33009259 DOI: 10.1097/icl.0000000000000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Neurotrophic keratopathy (NK) is a rare corneal condition characterized by epitheliopathy, which is associated with reduced or absent corneal sensation. The main goal of treatment of this condition is the preservation of ocular surface integrity. Contact lenses provide a nonsurgical and reversible option to provide the necessary corneal protection. The purpose of this review was to summarize the available literature regarding the use of contact lenses in the management of NK, with particular emphasis on the use of scleral lenses. METHODS Literature related to both soft and scleral contact lens use as treatment options for NK was reviewed. RESULTS As of yet, randomized clinical trials have compared neither the efficacy of contact lens therapy for NK to other therapeutic alternatives nor outcomes of therapy with different contact lens modalities. However, clinical case reports and limited case series have suggested that scleral lenses may be a safe and effective treatment option for NK at any stage of the disease, preserving epithelial integrity and even improving visual function in patients with this condition. CONCLUSIONS Scleral lenses may be effective in reducing the need for surgical intervention and improving the quality of life in patients with NK.
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24
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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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Indications for Wear, Visual Outcomes, and Complications of Custom Imprint 3D Scanned Scleral Contact Lens Use. Cornea 2020; 40:596-602. [PMID: 33252387 DOI: 10.1097/ico.0000000000002588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report indications for wear, visual outcomes, and complications of EyePrintPRO (EPP) scleral contact lens (SCL) use. METHODS A retrospective review identified all patients fitted with this device between December 2013 and March 2018. Baseline demographics, wear indication, and contact lens history were determined. Habitual-corrected visual acuity was measured at baseline and follow-up. Adverse wear symptoms and signs, reprinting, and device cessation were tracked. RESULTS Ninety-five eyes from 69 patients were followed for a median of 12.1 months (interquartile range 4.4-19.6). Indications for wear included vision improvement and/or ocular surface stabilization in the setting of irregular corneal shape (n = 68 eyes, 72%), ocular surface disease (n = 17, 18%), exposure keratopathy (n = 7, 7%), neurotrophic keratitis (n = 5, 5%), and extracorneal topographical abnormalities preventing noncustom lens fitting such as glaucoma drainage devices (n = 8, 8%). Median habitual-corrected visual acuity improved from 0.67 to 0.08 (P = 0.0003). One-third of eyes (33.1%) developed adverse wear symptoms. Fifteen of 95 eyes (16%) developed adverse wear signs. Device cessation occurred in 10 eyes (10.5%) and reprinting occurred in 14 eyes (14.7%) unrelated to prior lens wear or indication (P = 0.67 and 0.15, respectively). In eyes that previously failed SCLs (n = 56), 12 eyes required reprinting and 49 eyes continued use. CONCLUSIONS Indications for EPP wear include irregular corneal shape, ocular surface disease, and extracorneal topographic abnormalities. Visual acuity improves with the use of EPP. Clinicians and patients should be aware of potential adverse wear symptoms/signs and device cessation that may occur with EPP use. EPP is a viable salvage therapy in eyes that previously failed SCLs.
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26
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Nau A, Shorter ES, Harthan JS, Fogt JS, Nau CB, Schornack M. Multicenter review of impression-based scleral devices. Cont Lens Anterior Eye 2020; 44:101380. [PMID: 33199216 DOI: 10.1016/j.clae.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/18/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe outcomes using impression based-scleral devices for the management of anterior segment disease. METHODS Retrospective chart review identified all patients who were fitted with impression-based scleral devices between January 1, 2013 and June 30, 2019 at three specialty contact lens practices. Patient demographic data, indication for device use, visual and physiological outcomes, as well as details of the fitting process and survival of device use were determined. RESULTS Forty-four patients (70 eyes) were included in the study. Primary indications for device use included corneal irregularity (28 patients, 44 eyes) and ocular surface disease (16 patients, 26 eyes). Fifty-four percent of patients had more than one ocular surface condition, and 39 % of patients had undergone at least one anterior segment surgical procedure. Twenty-nine patients had unsuccessfully attempted to wear standard scleral lenses prior to being fit with impression-based devices. Visual acuity improved significantly with impression-based devices compared to habitual correction (p < 0.001). Completion of the fitting process (including visit to acquire the impression and post-fitting assessments) required an average of 4 [1.5] visits.Ideal haptic alignment was achieved with 74 % and complete limbal clearance was achieved in 83 % of fits. Device use was discontinued due to complications in two eyes. CONCLUSION Patients with complex eye disease who are unable to successfully wear standard scleral lenses successfully may achieve visual and therapeutic success with impression-based devices.
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Affiliation(s)
- Amy Nau
- Korb & Associates, Boston, MA, USA; New England College of Optometry, Boston, MA, USA.
| | | | | | - Jennifer S Fogt
- Ohio State University College of Optometry, Columbus, OH, USA
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Walker MK, Schornack MM, Vincent SJ. Anatomical and physiological considerations in scleral lens wear: Conjunctiva and sclera. Cont Lens Anterior Eye 2020; 43:517-528. [PMID: 32624363 DOI: 10.1016/j.clae.2020.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
Abstract
While scleral lenses have been fitted using diagnostic lenses or impression moulding techniques for over a century, recent advances in anterior segment imaging such as optical coherence tomography and corneo-scleral profilometry have significantly improved the current understanding of the anatomy of the anterior eye including the morphometry of the conjunctiva, sclera, and corneo-scleral junction, as well as the ocular surface shape and elevation. These technological advances in ocular imaging along with continual improvements and innovations in scleral lens design and manufacturing have led to a global increase in scleral lens prescribing. This review provides a comprehensive overview of the conjunctiva and sclera in the context of modern scleral lens practice, including anatomical variations in healthy and diseased eyes, the physiological impact of scleral lens wear, potential fitting challenges, and current approaches to lens modifications in order to minimise lens-induced complications and adverse ocular effects. Specific topics requiring further research are also discussed.
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Affiliation(s)
- Maria K Walker
- University of Houston College of Optometry, The Ocular Surface Institute, Houston, USA
| | | | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Institute of Health and Biomedical Innovation, Queensland, Australia.
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Lafosse E, Wolffsohn JS, Talens-Estarelles C, García-Lázaro S. Presbyopia and the aging eye: Existing refractive approaches and their potential impact on dry eye signs and symptoms. Cont Lens Anterior Eye 2019; 43:103-114. [PMID: 31445772 DOI: 10.1016/j.clae.2019.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/18/2023]
Abstract
Every part of the human body is subject to aging, including the eye. An increased prevalence of dry eye disease with age is widely acknowledged. Aging threatens ocular surface homeostasis, altering the normal functioning of the lacrimal functional unit and potentially leading to signs and symptoms of dry eye. Additional age-related processes take place within the crystalline lens, leading to presbyopia and cataractogenesis. Correction strategies for presbyopia and cataracts may directly or indirectly challenge the ocular surface. Contact lenses disturb the normal structure of the tear film and can interact negatively with the ocular surface, further deteriorating an already unbalanced tear film in presbyopes, however, newer contact lens designs can overcome some of these issues. Moreover, cataract and corneal refractive surgeries sever corneal nerves and disrupt the corneal epithelium and ocular surface, which can influence surgical outcomes and aggravate dryness symptoms in older age groups. This review summarises the current understanding of how the invasive nature of contact lens wear and cataract and refractive surgery influence signs and symptoms of ocular dryness in an aging population.
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Affiliation(s)
- E Lafosse
- Optometry Research Group, Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain; Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - J S Wolffsohn
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - C Talens-Estarelles
- Optometry Research Group, Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain
| | - S García-Lázaro
- Optometry Research Group, Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain.
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Abstract
PURPOSE OF REVIEW The prevalence and burden of dry eye disease continues to grow at a rapid pace, creating an increased need for new therapies. In a sector once limited to only a handful of treatments, clinicians now have multiple options available for patients who fail traditional therapies. This review summarizes the various treatment options available to clinicians treating complex dry eye disease patients. RECENT FINDINGS As we better understand the multifactorial mechanisms leading to dry eye disease, treatments increasingly focus on the amelioration of the underlying deficiencies and inflammation, rather than on transient symptomatic relief alone. Most topical medications seek to replace deficient growth factors and/or decrease inflammation on the ocular surface. The majority of new devices and procedures seek to treat meibomian gland dysfunction, with one new device stimulating tear production through utilizing the nasolacrimal reflex pathway. SUMMARY Clinicians have more options at their disposal in the treatment of dry eye disease than ever before, including topical medications and devices.
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30
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Schornack M, Nau C, Nau A, Harthan J, Fogt J, Shorter E. Visual and physiological outcomes of scleral lens wear. Cont Lens Anterior Eye 2019; 42:3-8. [DOI: 10.1016/j.clae.2018.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
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31
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Fadel D, Kramer E. Potential contraindications to scleral lens wear. Cont Lens Anterior Eye 2019; 42:92-103. [DOI: 10.1016/j.clae.2018.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/28/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
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