Corneoscleral contact lenses for visual rehabilitation after keratoplasty surgery.

PURPOSE: To report the use of corneoscleral lenses (CSL) in keratoconus patients who were unsatisfied with their visual outcomes after keratoplasty surgery. METHODS: Eleven consecutive cases with unsatisfactory vision with spectacles, due to irregular astigmatism, preferred to try CSL before SL due to handling or economic issues. An eye examination included refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count (ECC) and evaluation of corneal biomechanical parameters (corneal resistance factor, CRF; corneal hysteresis, CH; corneal-compensated intraocular pressure, IOPcc). The fitting process was performed using a diagnostic fitting set. Subjective visual quality and comfort, and CSL usage time were also recorded. Patients were monitored for 1 year. RESULTS: Two patients presented intolerance to CSL. Therefore, nine patients (6 males and 3 females; the mean±SD age, 44.56 ± 17.33 years, range 27-82) were fitted with CSL. The log MAR visual acuity of these eyes improved significantly with CSL in relation to the best spectacle-corrected vision (0.02 ± 0.06 vs 0.22 ± 0.15, respectively; p = 0.007). Patients reported prolonged usage times (an average of 9.78 ± 1.99 h; range, 8-14). No significant adverse ocular effects or clinically relevant changes in ocular parameters (ECC, CH, IOPcc, central corneal thickness and keratometry; all p > 0.05), visual quality, comfort rating or usage time were found during the 1-year follow-up. CONCLUSION: Corneoscleral lenses could be fitted in non-severe cases after keratoplasty surgery with optimal visual results as they can be a safe and healthy alternative option.

Fitting Scleral Lenses Less Than 15 mm in Diameter: A Review of the Literature.

OBJECTIVE: To perform a comprehensive review of the current and historical scientific literature on fitting small scleral lenses (diameter <15 mm) and clarifying their advantages and disadvantages, in addition to their clinical applications. METHODS: The literature search was performed through PubMed from MEDLINE. RESULTS: Eleven studies of case series (258 eyes) were found. Indications were similar to those of larger scleral lenses, 74% for corneal irregularities (mainly keratoconus), whereas 26% for ocular surface diseases. In the studies on cases of irregular corneas, visual acuity improved significantly regarding the values before and after fitting the lenses (mean, 0.4-0.03 logMar, respectively). Moreover, no significant adverse effects on the ocular surface were reported, and most studies reported over 10 hr (or thereabouts) of daily wear without removing the lenses. A better corneal physiology and visual quality, easier fitting procedure and lens handling, and prolonged hours of wear are proposed as significant advantages over larger scleral lenses. CONCLUSION: Small scleral lenses may be a safe and healthy alternative option to treat corneal irregularities and ocular surface diseases. These lenses can be fitted when it is necessary to improve visual quality and corneal physiology, when discomfort with other contact lenses is experienced, or when patients have difficulty handling larger diameters of scleral lenses. However, fitting these lenses is not suggested in severe cases or when it is not a reasonable clinical option.

Impact of Corneoscleral Contact Lens Usage on Corneal Biomechanical Parameters in Keratoconic Eyes.

OBJECTIVE: To analyze the changes in corneal biomechanical parameters of keratoconic eyes with and without intracorneal ring segment (ICRS) implants after 1 year of corneoscleral contact lens (CScL) wear. METHODS: Seventy-four eyes of 74 patients were divided into three groups: healthy subjects (29 eyes, control group), and 2 groups of subjects with keratoconic eyes (one group of 20 eyes with ICRS implants and one of 25 eyes without them), which were fitted with CScL. Corneal hysteresis (CH), corneal resistance factor (CRF), and corneal-compensated intraocular pressure (IOPcc) were evaluated before fitting CScL and after 1 year of CScL wear. In addition, endothelial cell count (ECC) and central corneal thickness (CCT) were also recorded. RESULTS: Corneal biomechanical parameters were lower in keratoconic corneas than in healthy corneas. Keratoconic eyes with ICRS implants had lower values than eyes without them for CH (mean±SD, 8.09±1.29 vs. 8.63±1.5 mm Hg, respectively, P=0.120), CRF (6.99±1.38 vs. 8.37±1.52 mm Hg, respectively, P=0.03), and also for CCT and ECC. Data for IOPcc were similar in all groups. After 1-year wearing CScL, no statistically significant differences in corneal biomechanical parameters were registered in any of the groups (all P>0.05), although slight differences (0.13-0.27 mm Hg) were found. CONCLUSION: The viscoelasticity properties of the cornea did not change significantly when wearing corneoscleral contact lenses for 1 year, and therefore, these lenses seem to be safe and healthy and are a reasonable alternative option for keratoconus management.

Visual quality with corneo-scleral contact lenses after intracorneal ring segment (ICRS) implantation for keratoconus management.

PURPOSE: To evaluate the visual quality results when fitting a corneo-scleral contact lens (CScL) after intracorneal ring segment (ICRS) implantation for keratoconus management. METHODS: Twenty-seven eyes of 27 patients with keratoconus underwent ICRS implantation and had CScL fitted as their visual quality was unsatisfactory with their spectacles or contact lenses. Patients received a complete eye examination, refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count, and visual quality assessment using contrast sensitivity and aberrometry tests. A diagnostic trial set was used in the fitting process, and patients were assessed according to a standardised methodology, including subjective visual quality and comfort, and contact lens usage time. The follow-up period was one year. RESULTS: After fitting CScL, log-MAR visual acuity values improved significantly in relation to the best spectacle-corrected vision (0.22 ± 0.17 vs 0.00 ± 0.12; p < 0.001). Total high-order aberrations decreased 33% (2.62 ± 1.31 vs 1.75 ± 1.81 µm; p < 0.009) and the spatial frequencies of contrast sensitivity all improved (all p < 0.05). Furthermore, 70.37% of patients reported high ratings of subjective visual quality (favourable and very favourable) and prolonged usage times (11.78 ± 3.93 h). After wearing CScL for one year, no adverse ocular effects or clinically relevant changes in corneal parameters, visual quality, comfort ratings or usage time were found. CONCLUSION: This CScL appears to be an alternative reasonable option for keratoconic eyes with ICRS placement, providing an improvement in subjective visual quality.

Corneoscleral contact lenses fitting on irregular corneas after laser-assisted in situ keratomileusis / Lentes de contato corneoesclerais adaptadas em córneas irregulares após cirurgia LASIK

ABSTRACT Purpose: We aimed to describe the outcomes of corneoscleral contact lens fitting with multi-aspherical geometry designs in patients with irregular corneas after laser-assisted in situ keratomileusis (LASIK). Methods: This was a retrospective series of 18 patients (age, 26-38 years) selected from an eye clinic database. Participants were required to have unsatisfactory visual acuity with their current contact lenses or spectacles after LASIK for myopia correction. All patients were fitted with corneoscleral contact lenses designed to correct corneal surface irregularities. A diagnostic trial set was used for fitting, and assessments were performed according to a standardized methodology. Subjective comfort, visual acuity, central corneal thickness, endothelial cell count, and corneal-compensated intraocular pressure were evaluated. The follow-up period was one year. Results: Contact lens use was discontinued in 3 patients, thus leaving 24 eyes from 8 females and 7 males for analysis. The fitting characteristics were optimal in terms of lens position and movement. Statistically significant improvements were found in the best spectacle-corrected vision from before fitting to the visual acuity after fitting (p<0.001). Moreover, the patients reported high subjective comfort ratings and usage times (12.98 ± 2.3 hours/day). After one year of wear, visual acuity, subjective comfort, and usage time were maintained. No statistically significant adverse changes developed in the corneas over this period. Conclusion: Corneoscleral contact lenses with a multi-aspherical geometry design provide optimal visual acuity, improved comfort, and prolonged usage times in patients with irregular corneas after LASIK.

RESUMO Objetivo: Descrever os resultados do ajuste de lentes de contato corneoesclerais com geometria multiasférica em pacientes com córneas irregulares após cirurgia de ceratomileuse in situ assistida por laser (LASIK). Métodos: Esta foi uma série retrospectiva de 18 pacientes (idade, 26-38 anos) selecionados a partir de um banco de dados de uma clínica oftalmológica. Os participantes foram escolhidos ao manifestaram acuidade visual insatisfatória com suas lentes de contato ou óculos atuais depois de terem sido submetidos à LASIK para correção de miopia. Todos os pacientes receberam lentes de contato corneoesclerais projetadas para corrigir irregularidades na superficie da córnea. Um conjunto diagnóstico de prova foi usado para a adaptação e as avaliações foram feitas de acordo com uma metodologia padronizada. O conforto subjetivo, a acuidade visual, a espessura central da córnea, a contagem de células endoteliais e a pressão intraocular compensada da córnea foram avaliados. O período de acompanhamento foi de um ano. Resultados: O uso de lentes de contato foi descontinuado em 3 pacientes, deixando 24 olhos de 8 mulheres e 7 homens para análise. As características de adaptação foram ótimas em termos de posição e movimento da lente. Melhorias estatisticamente significativas foram encontradas na melhoria da visão corrigida por óculos antes de se ajustar a acuidade visual após a adaptação (p<0,001). Além disso, os pacientes relataram altos índices subjetivos de conforto e tempo de uso (12,98 ± 2,3 horas/dia). Após um ano de uso, a acuidade visual, o conforto subjetivo e o tempo de uso foram mantidos. Não houve alterações adversas estatisti­camente significativas nas córneas ao longo deste período. Conclusão: As lentes de contato corneoesclerais com projeto geométrico multiasférico proporcionam acuidade visual ideal, maior conforto e tempo de uso prolongado em pacientes com córneas irregulares após o LASIK.

Corneoscleral contact lenses fitting on irregular corneas after laser-assisted in situ keratomileusis.

PURPOSE: We aimed to describe the outcomes of corneoscleral contact lens fitting with multi-aspherical geometry designs in patients with irregular corneas after laser-assisted in situ keratomileusis (LASIK). METHODS: This was a retrospective series of 18 patients (age, 26-38 years) selected from an eye clinic database. Participants were required to have unsatisfactory visual acuity with their current contact lenses or spectacles after LASIK for myopia correction. All patients were fitted with corneoscleral contact lenses designed to correct corneal surface irregularities. A diagnostic trial set was used for fitting, and assessments were performed according to a standardized methodology. Subjective comfort, visual acuity, central corneal thickness, endothelial cell count, and corneal-compensated intraocular pressure were evaluated. The follow-up period was one year. RESULTS: Contact lens use was discontinued in 3 patients, thus leaving 24 eyes from 8 females and 7 males for analysis. The fitting characteristics were optimal in terms of lens position and movement. Statistically significant improvements were found in the best spectacle-corrected vision from before fitting to the visual acuity after fitting (p<0.001). Moreover, the patients reported high subjective comfort ratings and usage times (12.98 ± 2.3 hours/day). After one year of wear, visual acuity, subjective comfort, and usage time were maintained. No statistically significant adverse changes developed in the corneas over this period. CONCLUSION: Corneoscleral contact lenses with a multi-aspherical geometry design provide optimal visual acuity, improved comfort, and prolonged usage times in patients with irregular corneas after LASIK.

Symptomatic accommodative and binocular dysfunctions from the use of flat-panel displays.

AIM: To determine the presence of symptomatic accommodative and non-strabismic binocular dysfunctions (ANSBD) in a non-presbyopic population of video display unit (VDU) users with flat-panel displays. METHODS: One hundred and one VDU users, aged between 20 to 34y, initially participated in the study. This study excluded contact-lens wearers and subjects who had undergone refractive surgery or had any systemic or ocular disease. First, subjects were asked about the type and nature of eye symptoms they experienced during VDU use. Then, a thorough eye examination excluded those subjects with a significant uncorrected refractive error or other problem, such as ocular motility disorders, vertical deviation, strabismus and eye diseases. Finally, the remaining participants underwent an exhaustive assessment of their accommodative and binocular vision status. RESULTS: Eighty-nine VDU users (46 females and 43 males) were included in this study. They used flat-panel displays for an average of 5±1.9h a day. Twenty subjects presented ANSBD (22.5%). Convergence excess was the most frequent non-strabismic binocular dysfunction (9 subjects), followed by fusional vergence dysfunction (3 subjects) and convergence insufficiency (2 subjects). Within the accommodative dysfunctions, accommodative excess was the most common (4 subjects), followed by accommodative insufficiency (2 subjects). Moderate to severe eye symptoms were found in 13 subjects with ANSBD. CONCLUSION: Significant eye symptoms in VDU users with accommodative and/or non-strabismic binocular dysfunctions often occur and should not be underestimated; therefore, an appropriate evaluation of accommodative and binocular vision status is more important for this population.

Visual quality with corneo-scleral contact lenses for keratoconus management.

PURPOSE: To assess the visual quality achieved by fitting corneo-scleral contact lenses (CScL) for keratoconus management. METHODS: Thirty patients with keratoconus presented to have CScL fitted because of the unsatisfactory visual quality they experienced with their contact lenses or spectacles. The eye examination included visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count, contrast sensitivity and aberrometry. The fitting process was performed using a diagnostic trial set. Subjective visual quality and comfort, and contact lens wear time were also reported. Patients were monitored for one year. RESULTS: Three patients discontinued CScL wear before one year. Therefore, 27 eyes of 27 patients (19 male and 8 female) participated in this study. The mean age was 36.1 ±â€¯13.1 (mean ±â€¯SD) years. Statistically significant differences were found in logMAR visual acuity between the best spectacle-corrected vision and after CScL fitting (mean ±â€¯SD, 0.23 ±â€¯0.30 and 0.00 ±â€¯0.14, respectively; p < 0.001). The total high-order aberrations decreased significantly (55%), and the spatial frequencies of contrast sensitivity all improved to normal range values of the population. Furthermore, high subjective visual quality and comfort ratings, and prolonged usage times (mean ±â€¯SD, 13.44 ±â€¯2.38 h a day) were reported. No adverse ocular effects or clinically relevant changes in corneal parameters, visual quality, comfort or usage time were found one year after wearing CScL. CONCLUSION: This CScL seems to be safe and healthy, providing optimal visual quality, comfort and prolonged usage times in patients with keratoconus.

Corneal Biomechanical Parameters With Corneoscleral Contact Lenses in Post-Laser In Situ Keratomileusis Eyes.

OBJECTIVE: To evaluate corneal biomechanical parameters wearing corneoscleral contact lenses (CScL) in patients with irregular corneas after laser in situ keratomileusis (LASIK). METHODS: Data from patients fitted with CScL because of corneal surface irregularities after complicated LASIK surgery were selected by two eye clinics. Previously and after 1 year of CScL fitting, corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and central corneal thickness were evaluated. In addition, visual acuity, subjective comfort, and wearing time CScL were reported. RESULTS: The study comprised 27 eyes. Statistically significant differences were found in visual acuity between the best spectacle-corrected vision and after CScL fitting [mean±SD, 0.16±0.03 logarithm of the minimum angle of resolution (logMAR) and 0.01±0.06 logMAR, respectively; P<0.001]. In addition, the patients reported high subjective comfort ratings (22 eyes were comfortable or very comfortable) and prolonged usage times (mean±SD, 12.67±1.98 hr of continuous wear a day). Statistically significant differences were found in the CRF between before CScL fitting and after 1 year of CScL wear (mean±SD, 7.57±0.87 and 7.68±0.84 mm Hg, respectively; P=0.015). Central corneal thickness, CH, and IOPcc showed slight differences after 1 year of CScL wear (1.78 µm, 0.04 and 0.21 mm Hg, respectively). CONCLUSION: Corneal biomechanical parameters increased slightly, although significantly for CRF, apparently without adverse clinical effects in post-LASIK eyes with irregular corneas after wearing CScL for 1 year.

Corneo-scleral contact lenses in an uncommon case of keratoconus with high hyperopia and astigmatism.

PURPOSE: To analyse the visual quality achieved by fitting corneo-scleral contact lenses (CScL) in an uncommon case of bilateral keratoconus, high hyperopia and astigmatism. METHODS: A 45-year-old man presented for eye examination due to the unsatisfactory quality of his vision wearing soft toric contact lenses. He presented high hyperopia and astigmatism with bilateral keratoconus. He was fitted with CScL to correct his irregular astigmatism and ocular aberrations. A diagnostic trial set was used in the fitting process and he was assessed according to standardised fitting methodology. Visual acuity, corneal topography, biometry and ocular aberrations were evaluated. The follow-up period was 1year. RESULTS: The best spectacle-corrected visual acuity was 20/32 with +8.00/-4.50×30° for the right eye (RE) and 20/25 with +7.75/-2.25×120° for the left eye (LE). After CScL fitting, visual acuity was improved to 20/20 and 20/16 for the RE and LE, respectively. The patient wore these contact lenses an average of 13h a day. The total high order aberrations decreased by approximately 79% in the RE (2.37-0.50µm) and 47% in the LE (1.04-0.55µm) after CScL fitting. Visual quality and wearing time were maintained after 1year wearing CScL. In addition, no adverse ocular effects were found during this period. CONCLUSION: The present case report describes how the patient had CScL fitted successfully for management of keratoconus with high hyperopia and astigmatism. They provided optimal visual quality, along with prolonged use times and no adverse effects to the cornea.

Corneo-scleral contact lens in a piggyback system for keratoconus: A case report.

PURPOSE: We describe a case of fitting a corneo-scleral contact lens with a multi-aspheric geometry design (MAGD CScL) on top of a daily silicone hydrogel lens (piggyback system) for keratoconus management. METHODS: A 48-year-old man using soft toric contact lenses required an improvement in the unsatisfactory quality of his vision. He presented with bilateral asymmetric keratoconus with high myopia in the right eye (RE) and severe myopia in the left eye (LE). In addition, he had low vision in his LE because of a maculopathy. He was fitted with MAGD CScL to correct his irregular astigmatism. A diagnostic trial set was used in the fitting process and the patient was assessed according to a standardised fitting methodology. Visual acuity, corneal topography and contrast sensitivity were evaluated. The follow-up period was 1year. RESULTS: The best spectacle-corrected visual acuity was 0.5 logMAR for the RE with -10 D/-5 D×60° and 2 logMAR for the LE with -20 D/-3 D×105°. After fitting MAGD CScL, visual acuity improved significantly to 0.1 logMAR for the RE and 1.3 logMAR for the LE, as well as contrast sensitivity. The fitting parameters of the base curve, diameter, and power were 7.05mm, 12.60mm, -18.50 D and 7.15mm, 12.60mm, -19 D for the RE and LE, respectively. Optimal fitting characteristics were found in terms of lens position and lens movement. To increase the time of MAGD CScL wear, they piggybacked on daily silicone hydrogel lenses of low power (-0.5 D). The patient reported being comfortable with this piggyback system for approximately 15h a day. After 1year of using the piggyback system, visual quality and wearing time were maintained. In addition, no adverse ocular effects were found during this period. CONCLUSION: This case report shows that in this patient a MAGD CScL could be fitted successfully on a daily silicone hydrogel lens in a piggyback system for keratoconus management, providing good visual quality along with prolonged use times and without adverse effects on the cornea.

Post-LASIK Visual Quality With a Corneoscleral Contact Lens to Treat Irregular Corneas.

OBJECTIVE: To evaluate the visual quality results of fitting a corneoscleral contact lens with multiaspheric geometry design (MAGD CScL) in subjects with irregular corneas after laser-assisted in situ keratomileusis (LASIK) surgery. METHODS: From a database of patients evaluated for scleral contact lenses, we identified those with irregular corneas and visual problems after they underwent LASIK surgery for correcting myopia. They manifested unsatisfactory visual quality with their current contact lenses or glasses. Therefore, a MAGD CScL was fitted and monitored according to standardized fitting methodology. A diagnostic trial set was used in the fitting process. Visual acuity (VA), subjective visual quality (SVQ), and ocular aberrations were evaluated. A new re-evaluation of these parameters was performed after 1 year wearing MAGD CScL. RESULTS: Eighteen eyes of 18 patients (10 male and 8 female) with irregular cornea after LASIK surgery participated in this study; their ages ranged from 27 to 39 years (mean±SD, 32.6±3.8 years). All patients showed good fitting characteristics: optimal values were seen for lens position and lens movement. Statistically significant differences were found between before and after fitting MAGD CScL in the VA (mean±SD, 0.14±0.03 logMAR and 0.01±0.06 logMAR, respectively; P<0.001); ocular aberrations of second-order, coma, spherical; and the total higher-order aberrations (HOAs) (all P<0.001). The total HOAs decreased by approximately 78% to normal levels after fitting MAGD CScL. In addition, SVQ was also significantly improved after fitting MAGD CScL (16 eyes were favorable or very favorable). After 1 year wearing MAGD CScL, no statistically significant differences were found in the total HOAs and VA in regard to the initial fitting. CONCLUSIONS: Corneoscleral contact lens with multiaspheric geometry design is proposed as an effective procedure, providing a good VA and an optimal visual quality on irregular corneas after LASIK surgery in myopic subjects.

Visual and ocular effects from the use of flat-panel displays.

AIM: To evaluate the prevalence of eye symptoms in a non-presbyopic population of video display unit (VDU) users with flat-panel displays. METHODS: One hundred and sixteen VDU users with flat-panel display from an urban population participated in the study; their ages ranging from 20 to 34y. There were 60 females and 56 males. An eye examination to rule out the presence of significant uncorrected refractive errors, general binocular dysfunctions and eye conditions was carried out. In order to determine and quantify the type and nature of eye symptoms, participants were asked to answer written questionnaire and the results were grouped by gender, age and number of hours a day spent using a VDU. RESULTS: Seventy-two percent of participants reported eye symptoms related to VDU use. Eye symptoms from moderate-to-severe were found in 23% of participants. The main symptom was moderate-to-severe tired eyes (14%); followed by sensitivity to bright lights (12%), blurred vision at far distances (10%), eyestrain or dry eye or irritated or burning eyes (9%), difficulty in refocusing from one distance to another or headache (8%) and blurred vision at near or intermediate distances (<4%). Eye symptoms were greater among females (P=0.005) and increased with VDU use, markedly above 6h spent using a VDU in a typical day (P=0.01). CONCLUSION: Significant eye symptoms relate to VDU use often occur and should not be underestimated. The increasing use of electronic devices with flat-panel display should prompt users to take appropriate measures to prevent or to relieve the eye symptoms arising from their use.