Benefits of Scleral Lens in the Management of Irregular Corneas and Dry Eye Syndrome After Refractive Surgery.

OBJECTIVES: To evaluate the utility of the SPOT scleral lens (Oxygen Permeable Scleral Lens of Thonon; LAO, Thonon-les-Bains, France) in the management of the irregular cornea after refractive surgery. METHOD: We included 19 patients (35 eyes) with irregular corneas after refractive surgery. Patients were fitted with scleral lenses after the failure of conventional contact lenses adaptation. The ophthalmologic examination included measurement of best-corrected visual acuity (BCVA), slitlamp examination, and evaluation of ocular aberrations (Objective Scattering Index [OSI] and higher-order aberration [HOA]). RESULT: Scleral lens fitting increases significantly the BCVA from 0.33 (±0.25) to 0.08 (±0.13) LogMAR (P<0.001). There was also a significant decrease in Ocular Surface Disease Index from 66.2±22.8 to 42.4±18.9 (P<0.001). Ocular aberrations (OAs) are also significantly reduced by the scleral lenses, the mean OSI goes from 7.2 (±4.2) to 3.0 (±1.8) (P<0.001), OA from 2.58 (±1.34) to 1.98 µm (±2.31) (P=0.035), and HOA from 0.94 (±0.51) to 0.48 (±0.23) (P=0.0018). CONCLUSION: Fitting with scleral lenses improves patients' optical and ocular surface problems. Scleral lens restores BCVA and the quality of life. Fitting with scleral lenses is an alternative to further surgery on these fragile eyes and is sometimes the only viable treatment option for the patient.

Role of the Dorsal Posterior Parietal Cortex in the Accurate Perception of Object Magnitude in Peripheral Vision.

Following superior parietal lobule and intraparietal sulcus (SPL-IPS) damage, optic ataxia patients underestimate the distance of objects in the ataxic visual field such that they produce hypometric pointing errors. The metrics of these pointing errors relative to visual target eccentricity fit the cortical magnification of central vision. The SPL-IPS would therefore implement an active "peripheral magnification" to match the real metrics of the environment for accurate action. We further hypothesized that this active compensation of the central magnification by the SPL-IPS contributes to actual object' size perception in peripheral vision. Three optic ataxia patients and 10 age-matched controls were assessed in comparing the thickness of two rectangles flashed simultaneously, one in central and another in peripheral vision. The bilateral optic ataxia patient exhibited exaggerated underestimation bias and uncertainty compared to the control group in both visual fields. The two unilateral optic ataxia patients exhibited a pathological asymmetry between visual fields: size perception performance was affected in their contralesional peripheral visual field compared to their healthy side. These results demonstrate that the SPL-IPS contributes to accurate size perception in peripheral vision.

Correlation between Keratoconus and Pollution.

Introduction: Keratoconus is a corneal ectasia with multifactorial origin. Three risk factors for keratoconus are currently recognized: ultraviolet rays (UV), eye rubbing and atopy. In the current literature, other factors are evoked such as pollution, whose role in the physiopathology of keratoconus is unclear. The effects of particles matter (PM) 2.5 and 10 are the most studied and questioned in the scientific literature.Material and method: A correlation study was carried out to determine the influence of pollution on keratoconus. Fine particulate matter levels were measured according to available WHO data and were correlated with the prevalences of epidemiological studies. These measures were included in the study according to strict selection criteria.Results: The mean pollution rate of the selected studies was 29.1 ± 24.3 µg/m3 for PM2.5 and 57.2 ± 56.2 µg/m3 for PM10. The Pearson test shows a moderate correlation between the prevalence of keratoconus and the levels of PM2.5 (R = 0.51; p = .022) and a strong correlation with the levels of PM10 (R = 0.71; p < .001).Discussion: Fine particulate matter appears to be an emerging risk factor for keratoconus. They are thought to act indirectly by exacerbating known risk factors such as atopy and eye rubbing. And could have a direct action on the cornea by increasing the apoptosis of epithelial cells and interacting directly with the structure of collagen of the stroma.