Contact Lens Management On Irregular Cornea. Effect Of Contact Lenses On Cornea.

Purpose: Irregular astigmatism due to epithelial irregularities, epithelial and stromal dystrophies or corneal degenerations and ectasias cannot be sufficiently corrected with spectacles, and rigid gas permeable (RGP) contact lenses have become the mainstay of the treatment. This study was designed to find out Relation between lens wear and corneal surface changes, longstanding management of corneal irregularity with contact lenses without disturbing the corneal health. Method:Study design Retrospective case evaluation which was approved by NHL Institutional Review Board. The study was conducted according to tenets of Declaration of Helsinki. Considering proportion of subjects with positive changes in follow-up visits to be 60% for study power of 80% we need sample size of 100 subjects. Total 121 eyes of 98 subjects enrolled in the study. where 54%(53) were male and46%(45) were females, among all 55 keratoconus, 5 keratoglobus, 14 PMD, 17 Post LASIK, Post trauma, 18 Post PK and 3 Epithelial irregular corneal astigmatic eyes were fitted with suitable different types of contact lenses. Among keratoconus total 42(76.36%) and all 5(100%) keratoglobus subjects underwent corneal collagen cross linking with riboflavin at least one year before lens trials. Among post LASIK ectasia subjects all diagnosed with corneal irregularities at least 12 month before lens trials, 12(70%) of them underwent post LASIK corneal collagen cross linking with riboflavin at least before 6 months of lens trials. Post trauma corneal repair and in post penetrating keratoplasty lenses were tried only after 1 year post surgery. Conclusion: As per the findings, contact lenses do not produce much of alterations on corneal structure if fitted well.

Effect Of Contact Lens Correction On Tear Film

Purpose: This study is conducted to find out changes in tear films take place due to use of contact lensesin Irregular corneal astigmatisms. Aim is to evaluate changes in the quantity and quality of tear film with long term use of contact lenses. Method: Slit Lamp Biomicroscopy of the anterior segment (lids, cornea, and conjunctiva) was conducted. During this examination, Bulbar and limbal conjunctiva, lid margins and corneal surface analysis was done. Results: Tear volume:In terms of tear volume Clinically and statistically significant changes are found P= 1.89E-12Tear film integrity helps to maintain an optically uniform interface between air and the anterior surface on contact lens that would affect visual function. Dogruet al.4and Mohd-Ali et al.5reported that keratoconus patients have poor tear stability compared to normal people. Few studies have reported the effect of RGP contact lens wear on the tear film of eyes with keratoconus. Results from this study showed that prolonged RGP contact lens wear had a significant effect on tears quality of keratoconic eyes.This agreed with a study reported by Moon et al.6who found that tear film changes in keratoconus could be directly related to contact lens wear. In present study it is clear that all other causes of corneal irregularities also show change in tear volume in contact lens wear. All different RGP lenses as well as soft lens users are showing decrease in tear volume after continues use of 6 months. TFBT: Thai et al.7who stated that all contact lenses materials significantly and adverselyaffected tear physiology by increasing evaporation rate and decreasing tear thinning timeResults from this study agreed Mohd-Ali et al.8who found minimal changes in tear characteristics after 6 months of continuous wear of Dk value above 90. Present study found significant change in TFBT where theAnova calculation gives the P =9.02E-05 which is different from the previous finding. All different RGP lenses as well as soft lens users are showing decrease in TBFT after continues use of 6 months. No significant gender influence was found among the lens wearers. Conclusion: Subjects with irregular corneal astigmatism who wear RGP contact lenses have poor tear stability which needs to be evaluated appropriately during management of such patients; both systemic and ocular signs of dry eye condition should be managed prior and during contact lens wear. In soft lens wearers also tear volume and TFBT shows significant decrease. As per the results practitioner should examine contact lens users in proper follow-up intervals so that if necessary they may manage the tear related alterations if found clinically required. Possible causes could be masking of corneal surface from the lid interactions and reduced sensitivity due to adaptation.

Accommodative Status In Amblyopes And Its Effect On Quality Of Life

PURPOSE: The purpose of this study is to assess accommodative status in amblyopic subjects and its effect on quality of life.METHOD: A cross sectional non randomized study was performed at tertiary eye care hospital. Study was carried out in five stages starting from collection of demographic data, anterior and posterior segment evaluation followed by cycloplegic refraction of selected amblyopes. Lag of accommodation was measured post adaptation, via monocular estimation method (MEM). ASQE questionnaire was filled up by amblyopic subjects or their parents. In the final stage control subjects were evaluated in similar manner, their lag of accommodation was measured and ASQE questionnaire was been filled up by subjects. Statistical analysis was performed using SPSS software.RESULTS: Total of 91 subjects diagnosed with amblyopia wasenrolled in study between 3 to 21 years of age with a mean value of 9.6 ± 4 years. Best corrected Visual acuity in amblyopic eye was in range of 1.77 to 0.30 log unit, while in better or good eye visual acuity was in range of 0.00 to 0.17 Mean value of MEM retinoscopy for amblyopes was found out to be lag of OD :+1.32 ±0.59 D and OS +1.34 ±0.57 D , while that of control subjects was OD: +0.71 ±0.21 D , OS: 0.69±0.24 D.Paired t-test compares lag of accommodation obtainedin amblyopes to that of normal subjects .p value was found to be significant i.e. less than 0.001.For amblyopes R2 value came to be 2.6% while on the other hand R2value for controls was 87%.ASQE scoring for amblyopes was between range of 29 to 49 ,score for near work domain was 9.51 (mean of 1.58) for amblyopes , 6.78 (mean of 1.13)for controls.CONCLUSION: Accommodative response in amblyopic subjects was affected as well as their quality of life as compared to controls. Lag of accommodation directly correlates with the near domain of quality of life score in amblyopes.

Amblyopia And Quality Of Life

Introduction:Quality of Life is an important outcome measure in healthcare.Till today the Quality of Life of Indian amblyopic patient remains poorly understood, as there is no published study discussing them.Method:A prospective cross sectional design of 91 amblyopic subjectsbetween ages3 to 12 years were conducted.Age and gender matched subjectwithout any ocular pathologywere taken as controls.The subjects underwent detailed clinical evaluation. Amblyopia and Strabismus Questionnaire was translated to Gujarati language and psychometric properties were analysed. The subjects completed the validated Gujarati questionnaire.The differences in Quality of Life among amblyopes and controls were examined, according to age, gender andclinical features.Result:Amblyopia and Strabismus Questionnaire had an average content validity index was 0.86. The cronbach’s alpha coefficient for internal consistent reliability was 0.733.The correlation coefficient analysis examining the test retest reliability was 0.914. The mean total score ofAmblyopia and Strabismus Questionnairewas 82.84 +18.44. The mean score for amblyopic subjects were significantly lower (82.84 vs 97.69; p<0.05) than controls.There were no statistical significant differences in the total score and individual domains in respect of age and gender. Amblyopic patients with strabismus scored lower in the scale of social contact and appearance in comparison to the non strabismic amblyopes(p<0.05).Conclusion:The revised Gujarati version of the Amblyopia and Strabismus Questionnaireappears to be a valid and reliable questionnaire in clinical setting for Indian culture for Gujarati population. The amblyopes have a poorer Quality of Life.

Complex limbal choristoma in linear nevus sebaceous syndrome managed with scleral grafting.

Linear nevus sebaceous syndrome (LNSS) is characterized by nevus sebaceous, mental retardation, seizures, and ocular abnormalities such as complex limbal choistoma. A young male with history of mass in right eye and blackish discoloration of skin over right and left side of forehead since birth presented with foreign body sensation and diminished vision in right eye. Ocular examination showed mass over epibulbar region with chorioretinal coloboma and posterior staphyloma in right eye and megalocornea in left eye. Histopathology report revealed complex limbal choristoma with compound melanocytic nevus. The case was managed by surgical excision of the limbal mass and filling the gap with scleral graft.