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Biscevic A, Ahmedbegovic-Pjano M, Grisevic S, Bejdic N, Gilevska F, Patel S. Corneal Surface Elevation and Thickness in Relation to the Fit of Rigid Contact Lenses in Keratoconus and After Corneal Cross-Linking. Clin Ophthalmol 2024; 18:1587-1597. [PMID: 38855010 PMCID: PMC11162211 DOI: 10.2147/opth.s463305] [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: 02/07/2024] [Accepted: 05/17/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose To determine if factors pertaining to corneal thickness and elevation were linked to the prescribed back optic zone radius and overall diameter in keratoconus (group I), and cross-linked keratoconus (group II), cases successfully fitted with rigid contact lenses. Patients and Methods A review of cases adapted to contact lens wear (Rose K™) and assessed using Pentacam™ (for corneal anterior surface topography, astigmatism, elevation, and topographic thickness variation) was undertaken to determine the significance of any correlation with comfort, lens usage, grading of keratoconus, corrected distance visual acuity (with glasses and contacts), refractive error, prescribed lens powers, back optic zone radius and overall diameter values were assessed. Results Chief findings were, comfort was rated highly, lenses were worn for more than 10 hours/day in 75% of cases. RCL corrected distance logMAR acuities (median, mode, inter-quartile ranges) were 0.11, 0.12 (0.08-0.13) and 0.08, 0.08 (0.06-0.11) in groups I and II, respectively. Multiple linear regression revealed significant correlations (p<0.01) between the [A] back optic zone radius, the thinnest value of corneal thickness (x1) and anterior corneal surface elevation (x2). The respective r2 values were 0.471 in group I and 0.512 in group II. [B] overall diameter, x1 and x2. The respective r2 values were 0.282 in group I and 0.505 in group II. Conclusion RCLs were well-tolerated in both groups. The r2 values imply there is a 50% chance of correctly predicting the suitable back optic zone radius in both groups, a 50% chance of correctly predicting the overall diameter in group II and 28% in group I cases using just x1 and x2. The thinnest value of corneal thickness and anterior corneal surface elevation could be used to quickly select the BOZR and OD during RCL fitting. This has the potential to reduce chair-time, waste and improve efficiency.
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Affiliation(s)
- Alma Biscevic
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia, Herzegovina
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Zagreb, Croatia
| | | | - Senad Grisevic
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia, Herzegovina
| | - Nita Bejdic
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia, Herzegovina
| | - Fanka Gilevska
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia, Herzegovina
| | - Sudi Patel
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia, Herzegovina
- Laser and Refractive Surgery, Eye Clinic Svjetlost, Zagreb, Croatia
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Al-Atawi S, Alghamdi A, Alzahrani K. The Lifetime Expenditure in People with Keratoconus in Saudi Arabia. Vision (Basel) 2023; 7:52. [PMID: 37606498 PMCID: PMC10443371 DOI: 10.3390/vision7030052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
AIM This study measured and evaluated the socioeconomic burden of people living with keratoconus in Saudi Arabia. METHODS This study employed a cross-sectional design, a Keratoconus Economic Burden Questionnaire, and a convenient sample of 89 keratoconus patients (58.4% male) drawn from multiple regions in Saudi Arabia. It was conducted using online surveys, and the data were analyzed using appropriate quantitative techniques. RESULTS The mean age and annual income of the participants were 33.24 (SD = 6.82) years and USD 9046.52 (SD = 16,866.48), respectively, with only 37% being employed for wages. Up to 94.4% needed glasses or contact lenses at least once a week, and 73.0% received care from optometrists. The condition forced 45.9% of the respondents to change careers or leisure activities, with a further 51.3% having to take time off work. The mean annual out-of-pocket expenses for buying and maintaining glasses or contact lenses, as well as traveling and accommodation for keratoconus-related treatment were USD 2341.76 (SD = 3053.09), with 48.32 incurring upwards of USD 3240 over the period. The treatment costs increased with disease duration, r(89) = 0.216, p < 0.05. Regression results showed that the existence of comorbid eye disease, changing glasses at least once a year, and wearing either glasses or contact lenses at least once a week individually had statistically significant negative effects on the total annual keratoconus treatment costs, while disease duration, utilization of optometrists, and taking time off had a statistically significant increase on the total cost (p < 0.05). CONCLUSION With a prevalence rate of 1 in 375, progressive debilitation, and the lifetime nature of the disease, keratoconus is a critical public health concern in Saudi Arabia. The resulting visual impairment and discomfort, as well as both direct and indirect economic burdens, have considerable impacts on the patient's quality of life.
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Affiliation(s)
- Saleha Al-Atawi
- Optometry Department, Faculty of Applied Medical Science, Al Baha University, Al Baha 4781, Saudi Arabia
| | - Ali Alghamdi
- Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia
| | - Khaled Alzahrani
- Optometry Department, King Fahad Armed Hospital, Jeddah 23311, Saudi Arabia
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Noufal KH, Babu S. Short-term visual outcome with sclerocorneal contact lens on irregular cornea. Saudi J Ophthalmol 2023; 37:43-47. [PMID: 36968765 PMCID: PMC10032290 DOI: 10.4103/sjopt.sjopt_268_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/12/2022] [Accepted: 01/02/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE The purpose is to study the change in visual acuity obtained with sclerocorneal contact lens (SCL) in patients with irregular corneal astigmatism. METHODS A prospective pre-post observational study was designed to include consecutive consenting patients with irregular corneal astigmatism and best-corrected visual acuity worse than 6/12 and fitted with SCL. Visual acuity was assessed using Snellen charts before fitting SCL and 1 week after the fit and converted to the equivalent logMAR units for analysis. RESULTS We included 51 eyes of 41 patients with a mean age of 26.31 ± 8.86 of which 32 (78%) were men. Keratoconus was the most common indication (n = 42 eyes, 82.35%), followed by corneal scar (n = 3, 4%), post keratoplasty (n = 2, 4%), high myopia (n = 2, 4%), pellucid marginal degeneration (n = 1, 2%), and aphakia (n = 1, 2%). The mean overall uncorrected visual acuity improved significantly (P < 0.001) with SCL from 1.18 ± 0.34 logMAR (6/120 Snellen's equivalent) to 0.27 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting. The mean overall best spectacle-corrected visual acuity improved from 0.89 ± 0.45 logMAR (6/36 Snellen's equivalent) to 0.26 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting. CONCLUSION Sclerocorneal contact lens improves visual acuity significantly in patients with irregular corneal astigmatism and reduces the need for corneal transplantation.
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Kasıkcı M, Karalezli A, Eroğul Ö, Gobeka HH. Quantifying contact lens-related changes in keratoconus corneal topographic indices: an updated Pentacam Scheimpflug imaging analysis. Rom J Ophthalmol 2022; 66:245-256. [PMID: 36349169 PMCID: PMC9585500 DOI: 10.22336/rjo.2022.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 06/16/2023] Open
Abstract
Purpose: Slowing ectasia progression is critical for maintaining visual potential in keratoconus (KC), for which various therapeutic approaches have been implemented. A Pentacam Scheimpflug imaging device was used to quantify contact lens (CL)-related changes in keratoconus corneal topographic indices. Methods: Thirty KC patients (group 1; 60 eyes) were using one of the three CL (rigid gas-permeable CL (RGPCL)-10, hybrid CL (HCL)-10, and scleral CL (SCL)-10 patients). A control group included 30 KC patients (group 2; 60 eyes) not using CLs due to intolerance or inappropriateness. The Pentacam® HR Scheimpflug imaging device was used to measure topographic indices such as Km anterior, Km posterior, K max, corneal thickness (CT, corneal central, apex, and thinnest), corneal volume (CV), anterior chamber volume (ACV), and anterior chamber depth (ACD) at baseline, 3rd, 6th, and 12th months. Results: The mean ages for groups 1 and 2 were 32±10 and 31±09 years, respectively. Group 1 had a lower but statistically significant change in K max than group 2 (p<0.038). Also, group 1 had a minor but non-significant decrease in anterior and posterior keratometry values compared to group 2 (pKm ant. right/ left eye = 0.063/ 0.065 and 0.087/ 0.094, respectively). RGPCL users had significant changes in central CT, thinnest CT and ACD (p<0.041). SCL users had more stable changes than other CLs for the thinnest CT along with significant changes in K max, pachy apex and ACV (p<0.036). HCL users had significantly higher K max stability (p<0.039). Conclusion: Regular use of appropriate therapeutic CLs may help to stabilize corneal deformity, thereby slowing changes in corneal topographic indices in KC.
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Affiliation(s)
- Murat Kasıkcı
- Department of Ophthalmology, Mugla Sitki Kocman University Education and Research Hospital, Mugla, Turkey
| | - Aylin Karalezli
- Department of Ophthalmology, Mugla Sitki Kocman University Education and Research Hospital, Mugla, Turkey
| | - Özgür Eroğul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Hamidu Hamisi Gobeka
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey
- Department of Ophthalmology, Agri Ibrahim Cecen University Faculty of Medicine, Agri, Turkey
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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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Elagamy A, AlOmair N. Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients. Cont Lens Anterior Eye 2021; 45:101520. [PMID: 34686431 DOI: 10.1016/j.clae.2021.101520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/03/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE This study was conducted to evaluate the effects of long-term use of rigid gas-permeable (RGP) contact lenses on corneal endothelium in keratoconus (KC) patients using non-contact specular microscopy. In addition, the correlation between wearing duration of RGP lenses (years & hours /d) and endothelial morphometric changes in KC patients was performed. This may provide more useful data for clinical application of RGP contact lens. STUDY DESIGN This study was a prospective, observational, comparative, hospital based, nonrandomized, cross-sectional, and quantitative study. SUBJECTS AND METHODS The study included 40 eyes of non-wearer contact lens KC patients (group 1) and 38 KC eyes with a long history of Rose K2 RGP contact lens wearing (group 2). The corneal endothelial morphology such as endothelial cell density (ECD); coefficient of variation of cell area (CV); percentage of hexagonal cells (HEX); and central corneal thickness (CCT) were evaluated in all patients using SP3000P Specular Microscope. RESULTS The study included 40 eyes of non-wearer contact lens KC patients (20 mild KC eyes and 20 moderate KC eyes) and 38 KC eyes with a long history of RGP contact lens wearing (18 mild KC eyes and 20 moderate KC eyes). The mean duration of RGP lenses wearing was 5.67 ± 3.481 years & 12.11 ± 2.698 h/d in mild KC eyes and 7.15 ± 5.294 years &13.65 ± 2.889 h/d in moderate KC eyes. Wearing duration in hours in mild KC eyes showed a significant moderate negative correlation with ECD (r = -0.529, p = 0.024) and a moderate positive correlation with CV (r = 0.565, p = 0.015). In addition, wearing duration in years in moderate KC eyes showed a significant moderate negative correlation with ECD (r = -0.465, p = 0.039) and moderate positive correlation with CV (r = 0.627, p = 0.003). However, wearing duration in hours in moderate KC eyes showed a significant moderate negative correlation with HEX only (r = -0.490, p = 0.028). This study reported significant corneal thinning in contact lens wearer KC eyes in contrast to non-wearer KC eyes. CONCLUSION This study documented a significant correlation between a long-term use of Rose K2 RGP using the three-point touch and corneal endothelial morphometric changes in KC patients. In addition, the current study confirmed a significant corneal thinning in RGP contact lens wearer compared to non-contact lens wearer KC patients. Further studies are recommended to evaluate the association between different RGP lens materials with different oxygen permeability transmissibility; different lens design types; different fitting methods; the duration of contact lens wear and the endothelial morphometric changes in KC patients.
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Affiliation(s)
- Amira Elagamy
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia and Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Egypt.
| | - Norah AlOmair
- Optometry and Vision Sciences, Senior Optometrist, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Almusawi LA, Hamied FM. Risk Factors for Development of Keratoconus: A Matched Pair Case-Control Study. Clin Ophthalmol 2021; 15:3473-3479. [PMID: 34429579 PMCID: PMC8378899 DOI: 10.2147/opth.s248724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Keratoconus, a progressive ectatic corneal disorder, is believed to be multifactorial in etiology with interaction between genetic and environmental factors. To date, risk factors for the development of the disease are extensively debated and need to be identified since they play a critical role in disease prevention and management. This study aimed to analyze associations between several hereditary and environmental predictors and the development of keratoconus. PATIENTS AND METHODS This was a retrospective matched pair case-control study. The study was conducted in Ibn-Alhaitham eye teaching hospital between March 2016 and April 2017. Patients with keratoconus (cases) and their age- and gender-matched controls were asked about childhood and early teenage eye rubbing, ocular trauma, obesity, contact lens wear, smoking and sunlight exposure, family history of keratoconus, parental consanguinity and information related to socio-economic status. Univariable and multivariable conditional logistic regression analyses were used to test the significance of associations. RESULTS A total of 166 individuals (83 cases and 83 controls; 60.2% female) were included. On univariable analysis, eye rubbing, family history of keratoconus and parental consanguinity were significant risk factors for keratoconus, whereas all other factors were non-significant. On multivariable analysis, eye rubbing (odds ratio: 4.93; P < 0.01), family history of keratoconus (odds ratio: 25.52; P < 0.01) and parental consanguinity (odds ratio: 2.89; P = 0.02), again, emerged as significant risk factors for disease development. CONCLUSION Family history of keratoconus, eye rubbing, and parental consanguinity were significant risk factors for keratoconus development. These results support the evidence for multifactorial etiology, the most important factor being hereditary predisposition.
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Affiliation(s)
| | - Furkaan Majied Hamied
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Iraq
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Selective transepithelial ablation with simultaneous accelerated Corneal Cross-linking for corneal regularization of keratoconus: the STARE-X Protocol. J Cataract Refract Surg 2021; 47:1403-1410. [PMID: 33770171 DOI: 10.1097/j.jcrs.0000000000000640] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the changes in refractive outcomes and corneal aberrations in central and paracentral keratoconus after Selective transepithelial topography-guided photorefractive keratectomy combined with Accelerated Corneal Collagen Cross-Linking (STARE-X). Settings Centro polispecialistico Mediterraneo, Siena Crosslinking Center and University of Messina (Italy). Design Prospective, interventional, multi-centric study. Methods One hundred eyes of 100 patients underwent STARE-X protocol. Patients were subdivided into 2 groups: Group 1 with cone located within the central 3-mm zone (50 eyes); and Group 2 (50 eyes) with cone located outside the central 3-mm zone. Follow-up was two years at least for all eyes. Outcome parameters included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Corneal tomography and corneal wavefront aberrations were assessed and compared before and two years after the treatment. Results At 2 years UDVA, CDVA improved, as well as sphere, cylinder, K-max reduced after treatment in both groups (p<.001 respectively). Moreover, a statistically significant reduction was observed of total High-Order Aberrations Root Main Square (HOA RMS), Coma RMS and Spherical Aberration (SA RMS) in both groups (p<.001 respectively). However, CDVA improved more in Group 1 than in Group 2 (p<.02). Conclusion The STARE-X protocol demonstrated effective results in halting keratoconus progression and improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration at 2 years. Longer follow-up studies are warranted to observe further long-term CXL flattening effect on the cone.
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Bykhovskaya Y, Rabinowitz YS. Update on the genetics of keratoconus. Exp Eye Res 2020; 202:108398. [PMID: 33316263 DOI: 10.1016/j.exer.2020.108398] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
In the past few years we have seen a great acceleration of discoveries in the field of keratoconus including new treatments, diagnostic tools, genomic and molecular determinants of disease risk. Recent genome-wide association studies (GWAS) of keratoconus cases and population wide studies of variation in central corneal thickness and in corneal biomechanical properties confirmed already identified genes and found many new susceptibility variants and biological pathways. Recent findings in genetic determinants of familial keratoconus revealed functionally important variants and established first mouse model of keratoconus. Latest transcriptomic and expression studies started assessing novel non-coding RNA targets in addition to identifying tissue specific effects of coding genes. First genomic insights into better prediction of treatment outcomes are bringing the advent of genomic medicine into keratoconus clinical practice.
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Affiliation(s)
- Yelena Bykhovskaya
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States.
| | - Yaron S Rabinowitz
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States
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Histological Patterns of Epithelial Alterations in Keratoconus. J Ophthalmol 2020; 2020:1468258. [PMID: 32802486 PMCID: PMC7414345 DOI: 10.1155/2020/1468258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/23/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to confirm the presence of specific patterns of epithelial response in corneal buttons from keratoconus patients. Methods This was a retrospective and descriptive study. 90 penetrating keratoplasty specimens obtained from patients diagnosed with keratoconus were evaluated using bright-field microscopy. Morphologically identifiable characteristics including epithelial cell density and epithelial thickness were analyzed on hematoxylin and eosin- (H&E-) and periodic acid of Schiff- (PAS-) stained slides. Results Three distinctive patterns of epithelial alteration of the central cornea were established. Pattern 3, in which the central epithelium was as thick as peripheral epithelium, was the commonest (44.4%), followed by the pattern 2, defined as central epithelium thinner than periphery epithelium (38.9%), and the uncommonest pattern was number 1, with central epithelium thicker than the periphery (16.7%). Conclusions Three distinctive histologic patterns that could potentially have a diagnostic and prognostic value in keratoconus patients were found.
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Saraç Ö, Kars ME, Temel B, Çağıl N. Clinical evaluation of different types of contact lenses in keratoconus management. Cont Lens Anterior Eye 2019; 42:482-486. [DOI: 10.1016/j.clae.2019.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
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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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