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Bliss VH, Branjerdporn N, Ooi PJ, Teo LM, Tu J, Yeh J, Collins MJ, Vincent SJ. Corneal oedema during reverse piggyback scleral lens wear. Ophthalmic Physiol Opt 2023; 43:1065-1069. [PMID: 37170418 DOI: 10.1111/opo.13161] [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: 02/05/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE One clinical approach to address poor front surface wettability during scleral lens wear is the use of a "reverse piggyback" system (a soft contact lens applied to the anterior surface of a scleral lens). The aim of this study was to compare the magnitude of corneal oedema induced following short-term reverse piggyback scleral lens wear and standard scleral lens wear. METHODS Ten young (mean age 22 ± 6 years) healthy participants with normal corneas were recruited. On separate days, central corneal thickness and fluid reservoir thickness were measured using optical coherence tomography before and after 90 min of standard scleral lens wear (Kerectasia Alignment Tangent Torus diagnostic lenses, hexafocon A, Dk 100 × 10-11 (cm2 /s)(ml O2 /ml × mmHg), Capricornia Contact Lenses, capcl.com.au) and reverse piggyback scleral lens wear (the same scleral lens with a Dailies Total 1®, delefilcon A, Dk 140 × 10-11 (cm2 /s)(ml O2 /ml × mmHg), Alcon, alcon.com, applied to the anterior scleral lens surface). RESULTS After correcting for small variations in the initial central fluid reservoir thickness, central corneal oedema was similar between the reverse piggyback (2.32 ± 1.15%) and standard scleral lens conditions (2.02 ± 0.76%; p = 0.45). CONCLUSIONS Following 90 min of lens wear, the highly oxygen-permeable reverse piggyback system did not induce a clinically or statistically greater magnitude of central corneal oedema compared with standard scleral lens wear in young adults with healthy corneas. This approach may be suitable to address poor front surface scleral lens wettability or to correct residual refractive error during diagnostic scleral lens fitting.
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Affiliation(s)
- Vyasa H Bliss
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nathan Branjerdporn
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peng Jia Ooi
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Li Mei Teo
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jervis Tu
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Justin Yeh
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Queensland, Australia
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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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Abstract
Keratoconus (KC) is a progressive disease that leads to a decrease in visual acuity and quality and impairs vision-related quality of life. Contact lens (CL) application has a primary place and importance in the correction of the optic problems due to the disease. The corneal changes and increased irregular astigmatism that occur with KC progression necessitate special CL designs and fitting methods. In addition to disease stage, the patient's lens tolerance also plays a role in the application of CLs in KC patients. With recent advances in materials and design technology, the CLs used in the treatment of KC have developed considerably and there are various types available. In this review, we discuss the wide range of CLs, including rigid and soft lenses, hybrid and scleral lenses, and even custom lens designs, in light of recent scientific advances.
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Affiliation(s)
| | - Sevda Aydın Kurna
- University of Health Sciences Turkey, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
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Montalt JC, Porcar E, España-Gregori E, Peris-Martínez C. Visual quality with corneo-scleral contact lenses after intracorneal ring segment (ICRS) implantation for keratoconus management. Cont Lens Anterior Eye 2019; 42:111-116. [DOI: 10.1016/j.clae.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Scleral lens after intracorneal ring segments in patients with keratoconus. Cont Lens Anterior Eye 2018; 41:234-237. [DOI: 10.1016/j.clae.2017.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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Nonsurgical Procedures for Keratoconus Management. J Ophthalmol 2017; 2017:9707650. [PMID: 29430305 PMCID: PMC5753012 DOI: 10.1155/2017/9707650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. Methods A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. Results The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. Conclusions In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.
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Alipour F, Rahimi F, Hashemian MN, Ajdarkosh Z, Roohipoor R, Mohebi M. Mini-scleral Contact Lens for Management of Poor Visual Outcomes after Intrastromal Corneal Ring Segments Implantation in Keratoconus. J Ophthalmic Vis Res 2016; 11:252-7. [PMID: 27621780 PMCID: PMC5000525 DOI: 10.4103/2008-322x.188400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the feasibility and efficacy of mini-scleral design (MSD) contact lenses to treat keratoconus patients who were unsatisfied with the results of corneal inlay. Methods: In this prospective interventional case series, 9 eyes of 6 keratoconus patients who were unsatisfied with the results of corneal inlay were fitted with MSD contact lenses. Demographic data, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher order aberrations (HOAs) were evaluated before contact lens fitting. Corrected visual acuity by placing the MSD contact lens with or without over-refraction, and HOAs were measured one hour after contact lens fitting. One month after contact lens wearing, corrected visual acuity by placing the MSD contact lens with over-refraction and possible contact lens related problems were assessed. Ocular comfort and contact lens handling problems were asked in follow-up visits. The data was analyzed using descriptive statistical tests. Results: Nine eyes of 6 patients were successfully fitted with the mini-scleral lens. Fitting was ideal in 7 eyes and acceptable in 2 eyes. Mean corrected visual acuity by placing the MSD lens without over-refraction was 0.09 (range, 0.00-0.15) LogMAR which was significantly better than the mean BSCVA of 0.38 (range, 0.2-0.6) LogMAR (P = 0.007). The mean root mean square (RMS) of third-order coma and trefoil significantly decreased after MSD contact lens fitting (P = 0.012 and P = 0.015, respectively); however, changes in the fourth-order spherical aberration were not statistically significant (P = 0.336). Conclusion: Mini-scleral contact lenses may be helpful in the management of visually unsatisfied patients after corneal inlay.
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Affiliation(s)
- Fatemeh Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Rahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Ajdarkosh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mohebi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Feasibility of custom-made hydrogel contact lenses in keratoconus with previous implantation of intracorneal ring segments. Cont Lens Anterior Eye 2015; 38:351-6. [DOI: 10.1016/j.clae.2015.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 02/11/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022]
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9
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Soft contact lens fitting after intrastromal corneal ring segment implantation to treat keratoconus. Cont Lens Anterior Eye 2014; 37:377-81. [DOI: 10.1016/j.clae.2014.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 11/24/2022]
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Klühspies U, Grunder A, Goebels S, Schirra F, Seitz B. [Keratoconus lenses: the small correction miracle]. Ophthalmologe 2014; 110:830-6, 838. [PMID: 23948734 DOI: 10.1007/s00347-013-2819-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Keratoconus is a non-inflammatory corneal disease associated with a cone-shaped protrusion and progressive corneal thinning. Apart from progression control and stabilizing interventions, correcting the optical error induced by a mostly highly irregular corneal surface is of paramount importance with respect to quality of life and ability to work. This goal can be achieved efficiently by contact lenses with only rare adverse conditions. This article provides a current overview on contact lens fitting in keratoconus and presents own associated results.
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Affiliation(s)
- U Klühspies
- Kontaktlinsenambulanz, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 1, 66424, Homburg, Deutschland.
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Romero-Jiménez M, Flores-Rodríguez P. Utility of a semi-scleral contact lens design in the management of the irregular cornea. Cont Lens Anterior Eye 2013; 36:146-50. [DOI: 10.1016/j.clae.2012.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/18/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
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Dalton K, Sorbara L. Fitting an MSD (Mini Scleral Design) rigid contact lens in advanced keratoconus with INTACS. Cont Lens Anterior Eye 2011; 34:274-81. [DOI: 10.1016/j.clae.2011.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/29/2011] [Accepted: 05/17/2011] [Indexed: 10/18/2022]
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Sengor T, Kurna SA, Aki S, Ozkurt Y. High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients. Clin Ophthalmol 2011; 5:331-5. [PMID: 21468342 PMCID: PMC3065576 DOI: 10.2147/opth.s16727] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients. METHODS Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system. RESULTS INDICATIONS FOR USING PBCL SYSTEM WERE: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3-12 months); thereafter they tolerated rigid lenses alone except for 2 patients. CONCLUSION The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.
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Affiliation(s)
- Tomris Sengor
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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