Impact of thermo-mechanical skin treatment on refraction and keratometry in patients with dry eye disease and the implications for cataract surgery.

PURPOSE: To determine the changes in keratometry measurements and refraction in patients having the thermo-mechanical periorbital skin treatment, Tixel®, to treat dry eye disease (DED). METHODS: A multi-centre, prospective, non-masked study was conducted. DED patients were recruited in 3 international centres and were evaluated in 5 visits separated by an interval of 2 weeks except for the last visit which took place after 18 weeks from visit 1. The same clinical examination was performed at all visits: OSDI questionnaire, tear stability, keratometry, best corrected visual acuity and refraction. Tixel® treatment was applied at the first 3 visits. RESULTS: 89 participants (24 males/65 females; mean age: 55.0 ± 14.2 years) were included: 20 presented moderate DED symptoms and 69 severe DED symptoms. Significant differences were found for the spherocylindrical refraction (vector analysis) between visit 1 and visits 2 and 3. Following cumulative analysis, 11.86 % and 16.94 % of participants had more than 0.5 dioptre (D) change in mean keratometry and keratometric astigmatism, respectively, at 3 months post-treatment. A total of 5.40 % had a sphere and cylinder change greater than 0.50D and 16.21 % had the axis changed more than 10 degrees (vector analysis). These changes were particularly significant in patients with severe DED symptoms. CONCLUSIONS: Keratometry readings and refraction can change following thermo-mechanical skin treatment for DED, especially in those patients with severe DED symptoms. This should be considered as potential errors in intraocular lens calculations may be induced.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Opportunities and threats to contact lens practice: A global survey perspective.

AIM: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. METHODS: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years. RESULTS: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). CONCLUSIONS: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

CLEAR - Medical use of contact lenses.

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.

Comparison of surgical parameters using different lens fragmentation patterns in eyes undergoing laser-assisted cataract surgery.

PURPOSE: To compare surgical parameters among eyes undergoing laser-assisted cataract surgery (LACS) using different lens fragmentation patterns (LFP). METHODS: Prospective, randomized, unmasked clinical trial. One-hundred eyes underwent LACS and were randomly assigned to 1 of 3 LFP treatment groups: (1) laser capsulotomy only; no lens fragmentation (NLF) (n = 34); (2) three-plane chop (TPC) (n = 33); and, (3) pie-cut pattern (PCP) fragmentation (n = 33). Prechop phacoemulsification (PHACO) was performed on all eyes using the same femtosecond (FS) laser and active-fluidics PHACO machine. MAIN OUTCOME MEASURES: FS laser dock time (s), PHACO time (s), PHACO power (%), cumulative dissipated energy (CDE) (%-s), irrigating fluid volume, and operative time. RESULTS: The 3 treatment groups were comparable in terms of patient age (P = 0.164) and nuclear density (P = 0.669). FS dock time was higher in the PCP group (184.18 ± 25.86) compared to the TPC (145.09 ± 14.15) group (P < 0.001). PHACO time was significantly shorter in the PCP (23.19 ± 17.20 s) compared to TPC (35.27 ± 17.70) and NLF (46.15 ± 23.72) groups (P < 0.001). PHACO power was lower in the PCP (11.81 ± 3.71) compared to the NLF (14.41 ± 1.88) and TPC (14.04 ± 2.46) groups (P < 0.001). CDE was lower in the PCP (2.85 ± 2.32) compared to NLF (6.55 ± 3.32) and TPC (6.55 ± 5.45) groups (P < 0.001). Fluid volumes and operative times were similar. CONCLUSION: LFP can influence PHACO surgical parameters. Extensive fragmentation patterns such as PCP appear to lower PHACO time, power, and CDE and may potentially reduce the risk of PHACO related complications.

A review of the surgical options for the correction of presbyopia.

Presbyopia is an age-related eye condition where one of the signs is the reduction in the amplitude of accommodation, resulting in the loss of ability to change the eye's focus from far to near. It is the most common age-related ailments affecting everyone around their mid-40s. Methods for the correction of presbyopia include contact lens and spectacle options but the surgical correction of presbyopia still remains a significant challenge for refractive surgeons. Surgical strategies for dealing with presbyopia may be extraocular (corneal or scleral) or intraocular (removal and replacement of the crystalline lens or some type of treatment on the crystalline lens itself). There are however a number of limitations and considerations that have limited the widespread acceptance of surgical correction of presbyopia. Each surgical strategy presents its own unique set of advantages and disadvantages. For example, lens removal and replacement with an intraocular lens may not be preferable in a young patient with presbyopia without a refractive error. Similarly treatment on the crystalline lens may not be a suitable choice for a patient with early signs of cataract. This article is a review of the options available and those that are in development stages and are likely to be available in the near future for the surgical correction of presbyopia.

Femtosecond laser vs mechanical microkeratome for hyperopic laser in situ keratomileusis.

PURPOSE: To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser vs a mechanical microkeratome for the correction of low to moderate hyperopia. DESIGN: Retrospective, nonrandomized, interventional, comparative case series. METHODS: settings: Vissum Santa Hortensia, Madrid, Spain.study population and procedures: Patients who had undergone LASIK to correct their hyperopia using the 60-kHz IntraLase femtosecond laser were compared to age- and refraction-matched patients in whom the Moria M2 microkeratome was used. Visual and refractive results 3 months postoperatively were compared between both groups. RESULTS: A total of 144 eyes were analyzed (72 in each group). Mean preoperative sphere was +3.45 ± 1.0 diopters (D) in the IntraLase group vs +3.18 ± 1.3 D in the M2 group (P = .1). Results 3 months postoperatively were: mean residual sphere, +0.44 ± 0.6D vs +0.72 ± 0.8 D (P = .02), respectively; uncorrected visual acuity (UCVA), 0.89 ± 0.2 vs 0.80 ± 0.2 (P = .04); best spectacle-corrected visual acuity (BSCVA), 0.96 ± 0.2 vs 0.92 ± 0.2 (P = .2); safety index, 0.97 ± 0.1 vs 0.98 ± 0.1 (P = .5); efficacy index, 0.89 ± 0.2 vs 0.84 ± 0.2 (P = .3). CONCLUSIONS: Hyperopic LASIK performed with the IntraLase femtosecond laser seems to achieve better refractive results 3 months after the surgery compared to the M2 microkeratome, without significant differences in safety between both procedures.

Surgical flap amputation for central flap necrosis after laser in situ keratomileusis.

A 52-year-old man had uneventful bilateral myopic laser in situ keratomileusis (LASIK) with planned monovision. Three months later, the left eye was retreated to improve the near vision. On postoperative day 1, the uncorrected distance visual acuity (UDVA) was 0.95 and the patient reported mild ocular pain. Stage 2 diffuse lamellar keratitis was observed. Despite hourly prednisolone instillation, the UDVA decreased to 0.1 and central flap necrosis syndrome was diagnosed. The flap was lifted and stromal bed irrigation performed. One month later, the UDVA was 0.05 with a hyperopic shift of +3.25 diopters and the flap, which had central haze and several striae, was amputated. Four months later, the UDVA was 0.05 with residual irregular astigmatism. Customized transepithelial photorefractive keratectomy (PRK) was performed; there were no postoperative complications. Three months after PRK, the UDVA was 0.8 with no refractive defect.

Comparison between femtosecond laser-assisted sub-Bowman keratomileusis vs laser subepithelial keratectomy to correct myopia.

PURPOSE: To compare femtosecond laser sub-Bowman keratomileusis (FSBK) vs laser subepithelial keratectomy (LASEK) to correct myopia. DESIGN: Retrospective, nonrandomized, interventional, comparative case series. METHODS: Two thousand one hundred and eight eyes were included in the study. We compared 1,072 eyes treated with FSBK vs 1,036 eyes treated with LASEK with or without mitomycin C (MMC). Visual and refractive results were evaluated 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: Preoperative mean sphere and best spectacle-corrected visual acuity (BSCVA) were -3.93 diopters (D) vs -3.87 D (P = .5) and 1.12 vs 1.12 (P = .8) in FSBK and LASEK, respectively. Uncorrected visual acuity (UCVA) was 0.92 vs 0.62, 0.98 vs 0.78, 0.96 vs 0.91, and 1.06 vs 1.03 in FSBK and LASEK, respectively, at 1 day, 1 week, and 1 and 3 months after surgery (P < .01 for all comparisons). Three months postoperatively, BSCVA was 1.13 and 1.10, respectively (P = .001). At that moment, 20 eyes (1.93%) in the LASEK group vs 9 eyes (0.84%) in the FSBK group had lost 2 or more lines of BSCVA. Ten eyes (0.96%) in the LASEK group gained 2 or more lines of BSCVA, whereas 3 eyes (0.28%) in the FSBK group gained 2 lines. Six months postoperatively, only 2 LASEK eyes (0.19%) showed loss of 2 or more lines of BSCVA, compared to 3 FSBK-treated eyes (0.28%). CONCLUSION: Both FSBK and LASEK are safe and effective procedures to correct myopia. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 3-month follow-up.

Comparative study of two silicone hydrogel contact lenses used as bandage contact lenses after LASEK.

PURPOSE: To evaluate two silicone hydrogel contact lens materials as continuous-wear bandage contact lenses after laser-assisted subepithelial keratomileusis (LASEK). METHODS: The inclusion criteria were myopia of -6.00 diopters (D) or less, astigmatism lower than -1.5 D, bilateral best-corrected visual acuity of 20/20 or better, and candidates for bilateral LASEK. The patients were randomized to be fitted with a Balafilcon A (PureVision) lens in one eye and Galyfilcon A (Acuvue Advance) in the fellow eye. Uncorrected visual acuity, corneal epithelial status, conjunctival and limbal hyperemia, lens movement, contact lens debris, and the responses to a subjective-comfort questionnaire were assessed postoperatively. The parameters were evaluated before and 1 and 5 days after the procedure. A paired Student's t-test and chi-square tests were used when appropriate. RESULTS: We analyzed 44 eyes of 22 consecutive patients who underwent LASEK to correct low-to-moderate myopia. The mean spherical equivalent was -3.25 +/- 2.36 D. There was no difference in conjunctival or limbal hyperemia, lens movement, uncorrected visual acuity, or epithelial healing between the two lenses at any visit. A significant difference was found in lens deposition and discomfort, which were greater with the PureVision lens 5 days postoperatively (p = 0.01 for both comparisons). CONCLUSIONS: PureVision and Acuvue Advance contact lenses seem to be useful as continuous wear bandage contact lenses. There is no major clinical difference between the lenses, although patients report greater comfort with Acuvue Advance.

Phakic refractive lens (Medennium) for correction of +4.00 to +6.00 diopters: 1-year follow-up.

PURPOSE: To study the efficacy and safety of phakic refractive lens (PRL) implantation to correct high hyperopia. METHODS: Inclusion criteria for this prospective, observer-masked, interventional study were spherical equivalent > or =+4.00 diopters (D) of cycloplegic hyperopia, best spectacle-corrected visual acuity (BSCVA) > or =0.5, anterior chamber depth > or =3 mm, and mesopic pupil size < or =6 mm. Lenses were implanted in all cases under regional anesthesia using forceps. RESULTS: Sixteen eyes of nine patients were included in the study. Mean preoperative spherical equivalent refraction was +5.65+/-1.41 D (range: +3.25 to +5.75 D). Mean 1-year postoperative spherical equivalent refraction was +0.07+/-0.43 D (range: -0.50 to 0.75 D). Fifteen (93.75%) eyes were within +/-0.50 D of emmetropia, and 16 (100%) eyes were within +/-1.00 D of emmetropia. Safety and efficacy indexes were 0.9 and 0.8, respectively. Eight (50%) eyes needed LASIK to correct residual astigmatism. Five (31.25%) eyes lost one line of BSCVA; no eye lost two or more lines of BSCVA. The BSCVA did not increase in any eye. No significant intraocular complications developed. CONCLUSIONS: Phakic refractive lens implantation to correct high hyperopia seems to be a safe and accurate procedure. A mild but significant loss in BSCVA can be anticipated.

Influence of preoperative keratometry on refractive results after laser-assisted subepithelial keratectomy to correct myopia.

PURPOSE: To study the relationship between preoperative keratometry and residual spherical equivalent (SE) after myopic laser-assisted subepithelial keratectomy (LASEK). SETTING: Vissum Madrid, Madrid, Spain. METHODS: This retrospective study comprised 1149 consecutive eyes that had LASEK to correct myopia. The relationship between preoperative keratometry and the 3-month postoperative SE was analyzed by linear regression. The same analysis was performed in the first decile (percentile 10) with the flattest keratometry readings, in the decile with the steepest readings, and in the quartiles with the lowest and highest preoperative myopia. RESULTS: Preoperatively, the mean SE was -4.59 diopters (D) +/- 2.80 (SD) (range -0.25 to -13.00 D) and the mean keratometry, 44.20 +/- 1.60 D (range 39.00 to 49.00 D). Three months postoperatively, the mean SE was +0.05 +/- 0.50 D. There was a significant (P = .04), although weak (r2 = 0.003), correlation between the mean preoperative keratometry and residual SE. Linear regression showed a positive significant correlation within each decile. The correlation was weak in the decile with the flattest corneas (115 eyes) (r2 = 0.04, P = .04) and slightly stronger in the decile with the steepest corneas (115 eyes) (r2 = 0.1, P = .001) (ie, the steeper the cornea, the greater the overcorrection). There was a weak correlation in the group with higher preoperative myopia (r2 = 0.05, P = .0003) but no correlation in the lower myopia group (P = .3). CONCLUSION: Preoperative corneal curvature did not seem to influence the spherical refractive outcomes after myopic LASEK.

Comparison of silicone and non-silicone hydrogel soft contact lenses used as a bandage after LASEK.

PURPOSE: To evaluate two different soft contact lens materials for continuous-wear bandage contact lenses after laser epithelial keratomileusis (LASEK). METHODS: A prospective, observer-masked study was conducted of 32 eyes of 16 consecutive patients. Inclusion criteria were candidates for bilateral LASEK, myopia of < or = -6.00 diopters (D), astigmatism < -1.50 D, and bilateral best spectacle-corrected visual acuity of 20/20 or better. Patients were randomly selected for a balafilcon A (PureVision; Bausch & Lomb) bandage contact lens in one eye and a poly-2-hydroxyethylmethacrylate-co-methacrylate glycerol (EquiS 60; mark'ennovy) in the fellow eye. Corneal epithelial status, conjunctival and limbal hyperemia, lens movement, contact lens debris, and the responses to a subjective comfort questionnaire were assessed postoperatively. The parameters were evaluated preoperatively and 1 and 5 days postoperatively. Paired Student t test and chi-square tests were used when appropriate. RESULTS: Thirty-two eyes of 16 consecutive patients who underwent LASEK to correct low to moderate myopia were analyzed. The mean spherical equivalent refraction was -3.25 D. There was no difference in conjunctival or limbal hyperemia, contact lens debris, or subjective comfort between lenses at any postoperative visit. In contrast, the corneal epithelial status was statistically better in the eyes with a silicone bandage contact lens 5 days after LASEK (P = .01). CONCLUSIONS: The results suggest that the bandage contact lens material used after LASEK affects the corneal epithelial healing process.

Incidence of diffuse lamellar keratitis after laser in situ keratomileusis associated with the IntraLase 15 kHz femtosecond laser and Moria M2 microkeratome.

PURPOSE: To analyze the incidence of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) performed with an IntraLase 15 kHz femtosecond laser (IntraLase, Corp.) or a Moria M2 mechanical microkeratome (Moria SA). SETTING: Vissum Madrid, Madrid, Spain. METHODS: This retrospective study compared the incidence of DLK in consecutive LASIK procedures performed with the IntraLase 15 kHz femtosecond laser (study group) or the Moria M2 microkeratome (control group). Two surgeons performed both types of surgeries (femtosecond laser and microkeratome) using the same excimer laser (Technolas 217, Bausch & Lomb). During the first week postoperatively, topical dexamethasone drops were applied 8 times daily in the femtosecond group and 4 times daily in the mechanical microkeratome group. RESULTS: A total of 2000 consecutive eyes were analyzed (1000 eyes in each group). Diffuse lamellar keratitis stage 2 developed in 1 patient in each group; DLK stage 3 developed in 4 patients in the study group and in no patient in the control group (P = .03). CONCLUSION: Despite more intense postoperative steroid treatment, DLK seemed to occur more frequently after LASIK performed with the IntraLase 15 kHz femtosecond laser than after LASIK performed with the Moria M2 microkeratome.