Preoperative Assessment of Corneal and Refractive Stability in Soft Contact Lens Wearing Photorefractive Candidates

Abstract

This pilot study compared traditional methodologies; manifest refraction and keratometry, with that of newer technologies; corneal topography, and optical pachymetry, in assessing corneal and refractive stabilization after soft contact lens wear in photorefractive candidates. The timeline differences among these various technologies in determining refractive and corneal stability were investigated. This was a masked prospective observational clinical study of full-time soft contact lens subjects on various wear schedules, all eligible candidates for photorefractive surgery. Subjects discontinued contact lens wear within 30 min of the initial study visit. During each study visit, the same sequence of tests were performed (manifest refraction, keratometry, corneal topography, and optical pachymetry). The timing of the last visit was determined when the four procedures resulted in stable findings when compared with the previous visit. Fifteen soft contact lens wearers and five noncontact lens wearing controls completed the study. The mean number of days until stability of the 15 test subjects were: 10.7 +/- 10.4 days with manifest refraction, 16.2 +/- 17.5 days with keratometry, 28.1 +/- 17.7 days with topography, and 35.1 +/- 20.8 days with pachymetry. Within the control group, intraclass correlation coefficients for all four methods were > or =0.89, indicating very little variability. Analysis with the randomized block design found statistical differences between traditional and newer technologies in their assessment of stability (p < 0.001). One-way Analysis of variance of the various soft contact lenses modalities suggested extended hydrogel wearers taking the longest time to reach stability after discontinuing full-time contact lens use. Corneal curvature and thickness measurements took the longest to achieve consistency. Thus, topography and pachymetry may be better methods to determine ocular stability before photorefractive surgery. In light of this finding, the current protocol in practice of determining the readiness of contact lens candidates for photorefractive surgery may be inadequate.