Corneal Rigid Gas-permeable Lenses Research Articles

Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation.

The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 (P < 0.001) after SLET and to logMAR 0.6 (P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.

Contact lens prescribing trends in the UK hospital eye service

The aim of this study was to evaluate the types of contact lenses fitted by hospital optometrists within the Midlands region of the United Kingdom (UK). A questionnaire was sent to all the lead optometrists of the Midlands Hospital Optometry Group (MHOG). This group includes optometry hospital eye departments within the Midlands region of the UK. The questionnaire requested information of their last ten contact lens fitting appointments. Details of the patient's age, gender, lens type, wearing times, and presenting condition were retrospectively taken from the patients' records using the appointment diary to identify the last ten patients fitted with contact lenses. Details from a total of 109 contact lens fits were collected. This included 45 females and 64 males with a mean age of 39.4±17.4years. The mean wearing time was 6.3±1.0days per week and 10.7±5.1h per day. Sixty-one percent of the contact lenses fitted were for patients with keratoconus and over half of all the contact lenses fitted were corneal rigid gas permeable lenses. This study highlighted that the main reason for fitting contact lenses in hospital contact lens practice is primary corneal ectasia, and mainly keratoconus. Whilst most patients with keratoconus were fitted with corneal rigid gas permeable contact lenses, around 1 in 6 were fitted with soft contact lenses. This study addresses a gap in the literature about contact lenses fitted in UK hospitals and how they differ from community contact lens practice.

Visual Rehabilitation With Contact Lenses Following Open Globe Trauma.

To describe visual outcomes with various contact lens modalities in patients with a history of ocular trauma who underwent surgical open globe repair. Records of all patients with a history of open globe injury and repair at a tertiary care hospital between January 1, 2010, and December 31, 2016, were reviewed. Demographics, type of injury, and visual acuity were assessed before and after contact lens evaluation. Of 214 patients who underwent open globe repair, 29 (13.6%) were evaluated with a contact lens. Visual acuity improved in 97% (28 of 29) of patients from 1.47±0.75 to 0.67±0.71 logarithm of the minimal angle of resolution (logMAR) with manifest refraction to 0.28±0.45 logMAR with contact lenses (n=29; P<0.0001). Corneal opacity was the most common clinical indication (20 of 29) for fitting followed by aphakia (13 of 29). A range of contact lens modalities, including corneal rigid gas-permeable (12 of 28), soft (9 of 28), hybrid (3 of 28), scleral gas-permeable (2 of 28), and piggyback (2 of 28) lenses were prescribed. In this study, patients with a history of trauma and open globe repair with good neurosensory visual potential had improvements in visual acuity with contact lens greater than manifest refraction. Soft and gas-permeable lenses were used to improve visual acuity in patients with a history of open globe repair and corneal scarring, aphakia, iris abnormalities, or other ocular sequelae. Although corneal rigid gas-permeable lenses were prescribed most often, additional consideration should be given to other contact lens modalities, including soft, piggyback, hybrid, and scleral gas-permeable lenses.

Refitting a patient with pellucid marginal degeneration from a corneal rigid gas permeable lens to scleral lens

This case report describes a 66 years old male patient with pellucid marginal degeneration (PMD). The patient had fallen out of a regular follow-up scheme and presented with a poorly fitting corneal rigid lens that he had worn for almost five years. Correction had failed to improve vision in the left eye, so the patient wears a contact lens in his right eye only. Scleral lenses vault over the cornea, the tear layer between the lens and the cornea masks corneal irregularities and are a good correction option for corneal ectasias. This patient was fitted with an Onefit scleral lens that provided good visual acuity and comfort. Lens handling was no obstacle to this patient. A heart surgery postponed the first follow-up examination. Follow-up examination 8 months after the refit resulted in no changes of lens parameters as the fitting was still acceptable and the patient was happy. Attention to the inferior limbal clearance will be the focus at the next follow-up in 6 months’ time.

Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.

How to deal with Keratokonus – are there Contact Lens Related Problems in Sclerals?

SummaryScleral lenses have become a popular early treatment choice for patients with keratoconus. In a recent SCOPE (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) study group finding, 34% of practitioners, of 629 survey respondents, chose scleral lenses as their first treatment option for patients with corneal irregularity. Among all treatment choices for corneal irregularity, scleral lenses ranked second only to corneal rigid gas permeable lenses, from those responding. The SCOPE study group then polled a group of keratoconus patients wearing scleral lenses. Of 79 keratoconus patients reporting scleral lens wear in both eyes, 85% were somewhat or very satisfied with their vision. However, these patients also reported experiencing cloudy vision (59%), lens discomfort (67%), and difficulty with lens handling (63%) at some time over the previous two years.

Are scleral lenses safe for the meibomian gland?

SummaryNowadays, we are experiencing scleral lens rebirth through the development of new designs and materials respecting the anterior ocular surface represented by the cornea, the limbus and the anterior bulbar conjunctiva. But what about the posterior ocular surface, represented by the tarsal conjunctiva, the lid margin and meibomian glands? The interaction of the scleral lens with the posterior ocular surface will be assessed clinically in keratoconus patients wearing scleral lens for more than 2 years and compared in a randomized manner with soft lens, hybrid lens and corneal rigid gas permeable lens wearers and with control sample. Lid wiper epitheliopathy grade, tear film break up time, quality of meibum and meibomian gland trophicity will be compared between different groups…