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Tseng AM, Heur M, Chiu GB. Sustained descemetocele management with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment. Am J Ophthalmol Case Rep 2024; 36:102092. [PMID: 39036656 PMCID: PMC11260373 DOI: 10.1016/j.ajoc.2024.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/16/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose To report a case of a 67-year-old male who was successfully managed over a 7-year period for descemetocele secondary to ocular graft versus host disease (oGVHD) using Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment. Observations We previously reported on a patient managed with a PROSE device for severe dry eyes secondary to oGVHD, who subsequently developed a central corneal descemetocele. The patient was deemed a poor surgical candidate due to limbal stem cell deficiency secondary to oGVHD. Therefore, we elected to closely monitor the descemetocele as the patient continued PROSE therapy. The patient's descemetocele has been managed successfully without perforation throughout a 7-year follow-up period with corrected distance visual acuity remaining stable at 20/50 in the affected eye. Conclusions and importance Descemetoceles are an uncommon complication of ocular graft versus host disease. This is the longest published report of a corneal descemetocele managed with PROSE. Our report suggests that in appropriate patients who are at high-risk for post-surgical complications, PROSE in conjunction with other medical management should be considered as an alternative to corneal transplantation.
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Affiliation(s)
- Alexander M. Tseng
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
| | - Martin Heur
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
| | - Gloria B. Chiu
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, 1450 San Pablo Street, 4th Floor, Los Angeles, CA, 90033, USA
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Deshmukh RS, Das AV, Vaddavalli PK. Evolving Trends in the Diagnosis and Management of Keratoconus Over 3 Decades. Cornea 2024:00003226-990000000-00623. [PMID: 39012335 DOI: 10.1097/ico.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To report the trends in the clinical presentation, diagnosis, and management of keratoconus (KC) in patients presenting to a multitier hospital network over 33 years. METHODS This retrospective study included patients with KC presenting from 1987 to 2020. Patients with KC in at least 1 eye were included. The data of 20,576 patients included in this study were retrieved from the electronic medical record database. Data on patient demographics, ocular diagnosis, contact lens usage, and surgical history were collected and exported for analysis. Descriptive statistics and chi square test were used for statistical analysis. RESULTS A total of 20,576 KC cases were seen from 1987 to 2020. Mean age at diagnosis reduced from 29.3 years (1987-1991) to 22.2 years (2016-2020). Adults (76.64%) were commonly affected with a majority being male (61.25%). Use of contact lenses increased from 4.34% (2002-2006) to 11.23% (2016-2020). Of the total number of surgical interventions, collagen crosslinking (CXL) constituted more than 1/5th (22.28%) between 2007 and 2011, which increased to more than half between 2012 and 2016 (53.61%) and almost 3/4th (72.53%) between 2017 and 2020. Advances in lamellar surgery have led to more patients undergoing deep anterior lamellar keratoplasty (DALK) as compared with penetrating keratoplasty. In the last 8 years, 17.2% patients underwent surgery and the most common was CXL (14.77%) followed by DALK (1.72%) and penetrating keratoplasty (1.04%). CONCLUSIONS We report the trends in the clinical presentation and management of KC over 3 decades. In the last 33 years, advances in diagnostics have helped diagnose KC earlier. Contact lenses and advances in CXL have reduced the number of keratoplasties in KC, DALK being more common.
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Affiliation(s)
- Rashmi S Deshmukh
- Refractive Surgery & Cataract Service, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of EMR & AEye, L V Prasad Eye Institute, Hyderabad, India; and
| | - Pravin Krishna Vaddavalli
- Refractive Surgery & Cataract Service, L V Prasad Eye Institute, Hyderabad, India
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Cortina MS, Greiner MA, Kuo AN, Li JY, Miller DD, Shtein RM, Veldman PB, Yin J, Kim SJ, Shen JF. Safety and Efficacy of Epithelium-Off Corneal Collagen Cross-Linking for the Treatment of Corneal Ectasia: A Report by the American Academy of Ophthalmology. Ophthalmology 2024:S0161-6420(24)00282-3. [PMID: 38935041 DOI: 10.1016/j.ophtha.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia. METHODS A literature search of the PubMed database was most recently conducted in March 2024 with no date restrictions and limited to studies published in English. The search identified 359 citations that were reviewed in abstract form, and 43 of these were reviewed in full text. High-quality randomized clinical trials comparing epithelium-off CXL with conservative treatment in patients who have keratoconus (KCN) and post-refractive surgery ectasia were included. The panel deemed 6 articles to be of sufficient relevance for inclusion, and these were assessed for quality by the panel methodologist; 5 were rated level I, and 1 was rated level II. There were no level III studies. RESULTS This analysis includes 6 prospective, randomized controlled trials that evaluated the use of epithelium-off CXL to treat progressive KCN (5 studies) and post-laser refractive surgery ectasia (1 study), with a mean postoperative follow-up of 2.4 years (range, 1-5 years). All studies showed a decreased progression rate in treated patients compared with controls. Improvement in the maximum keratometry (Kmax) value, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) was observed in the treatment groups compared with control groups. A decrease in corneal thickness was observed in both groups but was greater in the CXL group. Complications were rare. CONCLUSIONS Epithelium-off CXL is effective in reducing the progression of KCN and post-laser refractive surgery ectasia in most treated patients with an acceptable safety profile. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria S Cortina
- Department of Ophthalmology and Visual Science, University of Illinois College of Medicine, Chicago, Illinois
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Anthony N Kuo
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, California
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Peter B Veldman
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Jia Yin
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joanne F Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
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4
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Yu C, Xu J, Heidari G, Jiang H, Shi Y, Wu A, Makvandi P, Neisiany RE, Zare EN, Shao M, Hu L. Injectable hydrogels based on biopolymers for the treatment of ocular diseases. Int J Biol Macromol 2024; 269:132086. [PMID: 38705321 DOI: 10.1016/j.ijbiomac.2024.132086] [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: 12/28/2023] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Injectable hydrogels based on biopolymers, fabricated utilizing diverse chemical and physical methodologies, exhibit exceptional physical, chemical, and biological properties. They have multifaceted applications encompassing wound healing, tissue regeneration, and across diverse scientific realms. This review critically evaluates their largely uncharted potential in ophthalmology, elucidating their diverse applications across an array of ocular diseases. These conditions include glaucoma, cataracts, corneal disorders (spanning from age-related degeneration to trauma, infections, and underlying chronic illnesses), retina-associated ailments (such as diabetic retinopathy, retinitis pigmentosa, and age-related macular degeneration (AMD)), eyelid abnormalities, and uveal melanoma (UM). This study provides a thorough analysis of applications of injectable hydrogels based on biopolymers across these ocular disorders. Injectable hydrogels based on biopolymers can be customized to have specific physical, chemical, and biological properties that make them suitable as drug delivery vehicles, tissue scaffolds, and sealants in the eye. For example, they can be engineered to have optimum viscosity to be injected intravitreally and sustain drug release to treat retinal diseases. Their porous structure and biocompatibility promote cellular infiltration to regenerate diseased corneal tissue. By accentuating their indispensable role in ocular disease treatment, this review strives to present innovative and targeted approaches in this domain, thereby advancing ocular therapeutics.
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Affiliation(s)
- Caiyu Yu
- Department of Eye, Ear, Nose and Throat, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Wenzhou Central Hospital, Wenzhou 325000, China; School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiahao Xu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Golnaz Heidari
- School of Natural Sciences, Massey University, Private Bag 11 222, Palmerston North 4410, New Zealand
| | - Huijun Jiang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yifeng Shi
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Aimin Wu
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Pooyan Makvandi
- The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang 324000, China; Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh 174103, India; Department of Biomaterials, Saveetha Dental College and Hospitals, SIMATS, Saveetha University, Chennai 600077, India
| | - Rasoul Esmaeely Neisiany
- Biotechnology Centre, Silesian University of Technology, Krzywoustego 8, 44-100 Gliwice, Poland; Department of Polymer Engineering, Hakim Sabzevari University, Sabzevar 9617976487, Iran
| | - Ehsan Nazarzadeh Zare
- School of Chemistry, Damghan University, Damghan 36716-45667, Iran; Centre of Research Impact and Outreach, Chitkara University, Rajpura 140417, Punjab, India.
| | - Minmin Shao
- Department of Eye, Ear, Nose and Throat, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Wenzhou Central Hospital, Wenzhou 325000, China.
| | - Liang Hu
- Department of Eye, Ear, Nose and Throat, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Wenzhou Central Hospital, Wenzhou 325000, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
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Tariq U, Parveen S, Mahmood Wazir S, Khan TA, Zahid MA, Tariq Bangash M. Comparative Analysis of Keratometric and Pachymetry Values From Corneal Topography Scans: A Comparison Between Pentacam and Galilei. Cureus 2024; 16:e61993. [PMID: 38983996 PMCID: PMC11233126 DOI: 10.7759/cureus.61993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Objective The objective of this study was to compare K1, K2, Kmax, and pachymetry values from Pentacam and Galilei scans of corneal topography in order to assess their correlation and interchangeability in clinical practice. Methodology A total of 34 patients (68 eyes) were enrolled in the study. Corneal topography was performed using Pentacam and Galilei devices on the same day. K1, K2, Kmax, and pachymetry readings were obtained from the scans and analyzed using paired t-tests and Bland-Altman plots. Results There were minimal differences in clinical settings between Pentacam and Galilei for K1, K2, Kmax (>0.75 D), and pachymetry values (>15 um). However, there was a statistically significant difference found between Kmax and pachymetry, making their interchangeability questionable. Conclusion Pentacam and Galilei demonstrate a good correlation between corneal keratometric values (K1, K2, and Kmax) and pachymetry values in clinical settings, and they should be used interchangeably with caution.
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Affiliation(s)
- Usman Tariq
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
| | - Shagufta Parveen
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
| | | | - Taimoor A Khan
- Ophthalmology, National University of Medical Sciences, Rawalpindi, PAK
- Ophthalmology, Combined Military Hospital, Peshawar, PAK
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Vought R, Greenstein SA, Gelles J, Hersh PS. The Pathophysiology of Keratoconus. Cornea 2024:00003226-990000000-00572. [PMID: 38830186 DOI: 10.1097/ico.0000000000003585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Keratoconus is a progressive disease characterized by changes in corneal shape, resulting in loss of visual function. There remains a lack of comprehensive understanding regarding its underlying pathophysiology. This review aims to bridge this gap by exploring structural failures and inflammatory processes involved in the etiology and progression of keratoconus. METHODS A literature review was conducted using PubMed and Google Scholar databases, screening for articles published in English using the keyword combinations of "keratoconus" with "pathophysiology," "pathology," "metabolism," "inflammatory," "oxidative stress," "cytokines," "enzymes," "collagen," and "cornea." Articles published between January 1, 1970, and June 1, 2023, were queried and reviewed, with greater emphasis placed on more recent data. Fifty-six relevant studies were examined to develop a thorough review of the pathophysiological mechanisms at play in keratoconus. RESULTS Biomechanical structural failures in the cornea seem to be the primary militating factors in keratoconus etiology and progression. These include disruptions in the arrangement in the collagen lamellae, a decrease in collagen levels, a decrease in natural collagen crosslinking, and changes in lysosomal enzyme activity. Immunologic changes have also been identified in keratoconus, challenging the traditional view of the condition as noninflammatory. Elevated levels of proinflammatory cytokines like IL-1b, IL-6, IL-17, and TNF-α have been observed, along with increased apoptosis of keratocytes. Increased oxidative stress leads to the activation of collagenase and gelatinase enzymes. CONCLUSIONS Keratoconus is a complex condition influenced by both structural defects and inflammatory processes. Understanding these mechanisms can inform clinical management and potentially lead to more effective treatments.
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Affiliation(s)
- Rita Vought
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ; and
| | - Steven A Greenstein
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ; and
- Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, NJ
| | - John Gelles
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ; and
- Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, NJ
| | - Peter S Hersh
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ; and
- Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, NJ
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7
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Hagem AM, Thorsrud A, Sæthre M, Sandvik G, Kristianslund O, Drolsum L. Dramatic Reduction in Corneal Transplants for Keratoconus 15 Years After the Introduction of Corneal Collagen Crosslinking. Cornea 2024; 43:437-442. [PMID: 37851565 DOI: 10.1097/ico.0000000000003401] [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: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of the implementation of corneal collagen crosslinking (CXL) on the frequency of corneal transplants among patients with keratoconus (KC) in the same region. METHODS Before the introduction of CXL in 2007, 55 primary corneal transplants had been conducted in patients with KC (2005 and 2006) at the Department of Ophthalmology, Oslo University Hospital, Norway. We collected data from our corneal transplant registry for 2021 and 2022. The primary outcome was the number of corneal transplants performed in patients with KC. Age, sex, visual acuity (logarithm of the minimal angle of resolution), KC stage according to the Amsler-Krumeich classification system, and steepest keratometry reading (maximum keratometry, Pentacam, HR) were recorded. Furthermore, we registered the annual number of CXL treatments conducted from 2007 to 2022. RESULTS A total of 352 corneal transplants were performed in 2021 and 2022. Among them, 11 (3.1%) were transplants for patients with KC. All included patients were male; further, 90.1% and 9.1% of the patients were graded stages 4 and 3, respectively. The mean maximum keratometry was 79.0 diopter (range 61.0-109). The mean best-corrected visual acuity (logarithm of the minimal angle of resolution) was 1.3 (range 0.2-3.0). In 2021 to 2022, 431 CXL treatments were performed. CONCLUSIONS There was a significant decrease in the number of corneal transplants performed in patients with KC 15 years after the introduction of CXL. This indicates that the availability of CXL treatment over many years may considerably reduce the need for keratoplasties in this group of patients.
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Affiliation(s)
- Anne Marie Hagem
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Thorsrud
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Marit Sæthre
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Gunhild Sandvik
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; and
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Son HS, Nugent L, Wang J, Varadaraj V, Smith K, Bower KS, Mgboji G, Soiberman US, Srikumaran D. Factors Associated With Receipt of Crosslinking for Keratoconus. Cornea 2024; 43:214-220. [PMID: 37506367 PMCID: PMC10818004 DOI: 10.1097/ico.0000000000003353] [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: 01/26/2023] [Accepted: 06/11/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE The aim of this study was to identify factors associated with receipt of standard fluence epithelium-off crosslinking (CXL) for keratoconus (KCN). METHODS This retrospective, cross-sectional study reviewed electronic health records of treatment-naive patients with KCN seen at the Wilmer Eye Institute between January 2017 and September 2020. Tomographic data were derived from Pentacam (Oculus, Wetzlar, Germany) devices. Multivariable population-average model using generalized estimating equations adjusting for age, sex, race, national area deprivation index, vision correction method, and disease severity was used to identify factors associated with receipt of CXL. RESULTS From 583 patients with KCN, 97 (16.6%) underwent CXL for KCN. Patients who received CXL in at least 1 eye were significantly younger (mean 24.0 ± 7.8 years) than patients who had never undergone CXL (33.4 ± 9.3 years) ( P < 0.001). In multivariable analysis, Black patients had 63% lower odds of receiving CXL for KCN (OR: 0.37, 95% CI, 0.18-0.79) versus White patients, and older age was protective against receipt of CXL (OR: 0.89 per 1-year increase, 95% CI, 0.86-0.93). Comparison of characteristics by race demonstrated that Black patients presented with significantly worse vision, higher keratometric indices (K1, K2, and Kmax), and thinner corneal pachymetry at baseline versus White or Asian patients. CONCLUSIONS In this clinical cohort of patients with KCN from a tertiary referral center, Black patients were less likely to receive CXL presumably because of more advanced disease at presentation. Earlier active population screening may be indicated to identify and treat these patients before they become ineligible for treatment and develop irreversible vision loss. Such strategies may improve health equity in KCN management.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | - Liam Nugent
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Kerry Smith
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kraig S. Bower
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Glory Mgboji
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Uri S. Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Xiao G, Tsou BC, Soiberman US, Prescott CR, Srikumaran D, Woreta FA. Keratoplasty in the United States: Trends and Indications From 2015 to 2020. Cornea 2023; 42:1360-1364. [PMID: 36730420 DOI: 10.1097/ico.0000000000003180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020. METHODS This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran-Armitage test. RESULTS The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160-15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%-27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%-33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%-1.2%, P < 0.001).From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%-11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively. CONCLUSIONS From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.
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Affiliation(s)
- Grace Xiao
- Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Vilà Porsell I, Rodriguez Lopez A, Rocha-de-Lossada C, Rachwani Anil R, Sánchez Valera M. Evidence of Contact Lenses for Vision Rehabilitation in Corneal Diseases: A Review. Eye Contact Lens 2023; 49:301-309. [PMID: 37319415 DOI: 10.1097/icl.0000000000000991] [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: 03/21/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of contact lenses (CL) as a therapeutic option for patients affected by a corneal disease and to determinate which is the best lens modality for each disease. METHODS A literature review using PubMed was performed. All relevant articles published during the last 15 years have been included. RESULTS Various studies point to CL as the best therapeutic option for some corneal diseases and even as an alternative to surgery in some cases. After fitting, patients show an improvement in their functional vision and quality of life, in some cases being able to drive or work again. CONCLUSIONS There is a lack of scientific evidence to determine which lens modality is suitable for each corneal pathology. Currently, according to this review, the reason for choosing between the different options depends on the severity of symptoms, and it is worth mentioning that scleral lenses seem to be the best option in advanced stages of disease. However, the expertise of professionals is also an important factor at the time of choosing a particular CL modality. Standardized criteria are still necessary for correct selection of lens modality for a correct management of the disease.
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Affiliation(s)
- Irene Vilà Porsell
- Hospital Clinic de Barcelona (I.V.P., A.R.L., M.S.V.), Barcelona, Spain; Department of Ophthalmology (C.R.d.L.), Qvision, VITHAS Almería Hospital, Almería, Spain; Department of Ophthalmology (C.R.d.L.), Vithas Málaga, Málaga, Spain; Department of Ophthalmology (C.R.d.L.), Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Cirugía (C.R.d.L.), Universidad de Sevilla, Área de Oftalmología; Department of Ophthalmology (R.R.A.), Hospital Norte de Málaga, Antequera, Spain; Department of Ophthalmology (R.R.A.), Hospital Quirón Málaga, Spain; Department of Ophthalmology (R.R.A.), Hospital Vithas Málaga, Spain
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11
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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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Choi JH, Jeng BH. Indications for keratoplasty in management of corneal ectasia. Curr Opin Ophthalmol 2022; 33:318-323. [PMID: 35779056 DOI: 10.1097/icu.0000000000000862] [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 aims to describe recent advancements in treatment of corneal ectasias and its effect on indications for corneal transplantation. RECENT FINDINGS The majority of patients affected by ectatic corneal disease use contact lenses to correct resulting astigmatism. Patients who are intolerant of contact lenses or cannot achieve acceptable vision through conservative measures could consider keratoplasty. However, continuing advancements in both nonsurgical and surgical treatments are either reducing or delaying the need for keratoplasty in patients affected by ectatic corneal disease. SUMMARY Corneal transplantation has been the mainstay of treatment for patients with advanced ectatic corneal disease. In the past decade, numerous improvements have been occurred to make contact lenses not only more effective for visual correction, but also more comfortable. Although corneal cross-linking is the only proven treatment known to prevent progression of disease, several other therapies show early potential for those in which cross-linking is contraindicated. Patients now have access to a wider range of therapies before considering keratoplasty.
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Affiliation(s)
- Jamie H Choi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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Corneal Response to Scleral Contact Lens Wear in Keratoconus. Eye Contact Lens 2022; 48:322-327. [PMID: 35389370 DOI: 10.1097/icl.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify corneal alterations in patients with keratoconus who wear scleral contact lenses (ScCLs), focusing on corneal endothelial assessment. METHODS Scleral contact lenses were fitted in 22 patients with keratoconus. During a 90-day follow-up, patients were assessed in three visits: at baseline, after 30 days, and after 90 days. Patients underwent visual acuity measurement, slitlamp biomicroscopy of the anterior segment, specular microscopy of the corneal endothelium, corneal pachymetry, measurement of the clearance between the cornea and the lens, and follow-up of ectasia. RESULTS Variables related to endothelial morphology and pachymetry values did not change significantly over time. Central clearance measurements decreased in the 90-day period. No progression of corneal ectasia was observed, neither were infectious or inflammatory processes in the same period. CONCLUSION Daily wear of ScCLs in patients with keratoconus was not associated with adverse effects on the cornea or endothelium over a period of 90 days nor was there evidence of disease progression. Central clearance values diminished over that period, but the significance of this observation remains unclear.
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Scanzera AC, Deeley M, Joslin C, McMahon TT, Shorter E. Contact Lens Prescribing Trends for Keratoconus at an Academic Medical Center: Increased Utilization of Scleral Lenses for Severe Disease. Eye Contact Lens 2022; 48:58-62. [PMID: 35058416 PMCID: PMC8830690 DOI: 10.1097/icl.0000000000000869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe contact lens prescription trends for patients with keratoconus. METHODS Demographics, corneal curvature, visual acuity, and type of contact lens prescribed were reviewed for all patients with keratoconus evaluated in the contact lens service in 2010 and 2020. RESULTS There were 292 patients in 2010 and 217 in 2020. In 2010, 69% were using corneal gas-permeable lenses (GP), 16% soft toric, 13% hybrid, and 2% soft sphere with no scleral lens (SL). In 2020, 60% were using corneal GP, 22% SL, 12% soft toric, 5% hybrid, and 1% soft sphere. Mean log of minimum angle of resolution visual acuities with manifest refraction were (represented in mean [SD, range]) 0.42 (0.33, 0-1.3) in 2010 and 0.35 (0.33, 0-1.6) in 2020 improving to 0.19 (0.18, 0-1.3; P≤0.01) and 0.13 (0.14, 0-0.60; P<0.01) with contact lenses. Mean keratometry measurement in patients using SLs was 53.0 diopters (D) (9.9, 42.1-84.5), which was steeper than 46.6 D in patient's using all other lens types in 2010 and 2020 (3.9, 40.9-57.9; P<0.01). CONCLUSIONS Scleral lens prescription increased during the past decade; however, corneal GP lenses remain the most frequent lens prescribed for patients with keratoconus in this cohort. Despite being prescribed for patients with the most advanced disease, SLs provide good visual acuity.
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Affiliation(s)
- Angelica C Scanzera
- Department of Ophthalmology and Visual Sciences (A.C.S., C.J., T.T.M., E.S.), University of Illinois at Chicago, Chicago, IL; and Reed Eye Associates (M.D.), Rochester Regional Health, Rochester, NY
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15
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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 201] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - 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, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Richter K, Jullien T, Klühspies U, Langenbucher A, Seitz B, Eppig T. Contact Lens Fitting in Patients with Keratoconus - A Retrospective Assessment of 200 Patients. Klin Monbl Augenheilkd 2021; 239:1155-1163. [PMID: 34731900 DOI: 10.1055/a-1526-9861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes. PATIENTS AND METHODS This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting. RESULTS The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting. CONCLUSIONS The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.
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Affiliation(s)
- Kathrin Richter
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - Theresia Jullien
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - Ulrike Klühspies
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - Timo Eppig
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar
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Thanitcul C, Varadaraj V, Canner JK, Woreta FA, Soiberman US, Srikumaran D. Predictors of Receiving Keratoplasty for Keratoconus. Am J Ophthalmol 2021; 231:11-18. [PMID: 34048803 DOI: 10.1016/j.ajo.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To identify sociodemographic factors and comorbid conditions associated with receiving keratoplasty for keratoconus (KCN). DESIGN Retrospective, cross-sectional study. METHODS Health records of KCN patients <65 years of age from 2011 to 2018 were obtained from the IBM MarketScan Database. A multivariable model adjusted for potential confounders was used to examine factors associated with the risk of receiving keratoplasty. RESULTS Of 42,086 total patients with KCN identified, 1282 (3.0%) patients had keratoplasty to treat KCN. In the fully adjusted analysis, female sex (odds ratio [OR] 0.87 [95% confidence interval {CI} 0.78-0.98]) and living in metropolitan areas (OR 0.75 [95% CI 0.63-0.90]) were associated with lower odds of receiving keratoplasty. Compared with individuals 10 to 19 years of age, those 20 to 29 years of age (OR 1.77 [95% CI 1.31-2.41]) and 30 to 39 years of age (OR 1.61 [95% CI 1.19-2.17]) were more likely to have keratoplasty, while individuals in the older age groups (50-64 years of age) did not show statistically significant associations. Conditions associated with higher odds of receiving keratoplasty were corneal hydrops (OR 4.87 [95% CI 4.07-5.82]), Leber congenital amaurosis (OR 2.41 [95% CI 1.02-5.71]), sleep apnea (OR 1.46 [95% CI 1.25-1.71]), diabetes mellitus (OR 1.32 [95% CI 1.13-1.54]), and depression (OR 1.22 [95% CI 1.03-1.44]). Conditions associated with lower odds were previous contact lens usage (OR 0.61 [95% CI 0.50-0.74]) and a history of glaucoma (OR 0.60 [95% CI 0.49-0.73]). CONCLUSIONS This analysis of a large sample of patients with KCN reveals previously unidentified risk factors associated with receiving keratoplasty including Leber congenital amaurosis, depression, and diabetes. Future research should examine if young patients with these conditions may benefit from more frequent follow-up and/or early crosslinking to reduce the need for subsequent keratoplasty.
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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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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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Fisher D, Collins MJ, Vincent SJ. Fluid reservoir thickness and corneal oedema during closed eye scleral lens wear. Cont Lens Anterior Eye 2021; 44:102-107. [DOI: 10.1016/j.clae.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 01/12/2023]
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