ArticleLiterature Review

Scleral lens use in dry eye syndrome

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Abstract

Dry eye syndrome can be difficult to manage in severe or refractory cases. In patients in whom traditional treatments have limited efficacy, alternative treatments may be considered for dry eye syndrome, including scleral lenses. The present review summarizes the evidence regarding scleral lens use in dry eye syndrome. Scleral lenses have become a viable option for severe dry eye syndrome, and have been shown to be efficacious and well tolerated, with most reports citing improved visual acuity and relief of symptoms. Currently, there are 18 manufacturers of scleral lenses, although published reports on scleral lenses primarily focus on the BostonSight PROSE and the Jupiter Lens. Scleral lenses are efficacious and well tolerated for use in severe dry eye syndrome. Further research is needed to compare different sizes and types of lenses, and to standardize outcome measures.

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... Many OSDs, such as exposure keratopathy and graft-versus-host disease (GVHD), can cause DED, or similar signs and symptoms [5,9]. SLs are often prescribed for patients with OSDs for ocular surface protection, corneal healing, and ocular symptomatic relief [10,11]. As severe OSD can often result in corneal irregularity, SLs can also effectively rehabilitate vision in these cases [12,13]. ...
... As severe OSD can often result in corneal irregularity, SLs can also effectively rehabilitate vision in these cases [12,13]. The efficacy of SLs in the management of OSD with associated corneal irregularities, including GVHD, Stevens-Johnson syndrome (SJS), Sjögren's syndrome, exposure keratopathy, and post-refractive surgery dry eye, has been covered in previous review papers [10,11]. Overall, most reports have suggested the efficacy of SLs in managing OSD with studies of small sample size (level 2 evidence [7]), retrospective chart reviews (level 2 evidence [7]), or individual case reports (level 3 evidence [7]) [12]. ...
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Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations.
... ScCLs play an important role in eyes with DED. They are indicated for the correction of refractive error secondary to the irregular corneal surface, [88] for symptomatic relief, protection of the ocular surface, healing of epithelial defects, [89] and as a medium for constant drug delivery [90] to the ocular surface. Various authors have described the efficacy of ScCLs in general for DED [91] as well as for various conditions causing dry eyes including primary and secondary SS, [92] SJS, [93][94][95] GVHD, [96][97][98] exposure keratopathy, [99,100] neurotrophic keratopathy, [100] ocular cicatricial pemphigoid, atopic keratoconjunctivitis, and chemical and thermal injury. ...
... Fluid ventilation may be important for success with ScCLs in DED as described in some reports. [88,91,105,106] Weber et al. [107] studied impression cytology of patients of SS who wore ScCLs and found an increase in an inflammatory response in these eyes. Thus, further studies are needed to support the success of ScCLs in these patients. ...
Article
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Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.
... The visual outcome would need to be enhanced with the use of scleral lenses. [25] The possible occurrence of an epithelial defect in the postoperative period must be borne in mind and specifically looked for. ...
... Scleral contact lenses form an important addition to the management armamentarium to improve post-cataract patient comfort and vision in the presence of dry eye and corneal scars. [11,25,26] ...
Article
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Ocular surface disorders (OSDs) constitute a varied spectrum of conditions that could be associated with dryness, compromised limbal status, varying grades of forniceal obliteration, corneal scars, and a possible underlying immune etiology. These associations adversely impact surgical outcomes in the eye. One of the treatable causes of decreased vision in these eyes is cataracts which could be secondary to the disease, its treatment, or age-related. The compromised ocular surface status can interfere with decision-making regarding the technique of cataract surgery, preoperative biometry for intraocular lens (IOL) power calculation, and intraoperative visibility, increasing the possibility of complications and compromising the final visual outcome. The postoperative course can be affected by complications, including melt and infection. Stabilization of the ocular surface by medical or surgical means, and appropriate management of underlying immune etiology, if any, helps improve and maintain a healthy ocular surface, optimizing cataract outcomes. With the help of pre, intra, and postoperative tools and means, such as punctal occlusion, ocular surface reconstruction, systemic immunosuppression, illuminators, capsule staining dyes, optical iridectomy, prosthetic replacement of the ocular surface ecosystem (PROSE) lenses, and others, the visual outcome post-cataract surgery in these eyes can be maximized. This article highlights the nuances of performing cataract surgery in various OSDs and the need to have a comprehensive stepwise approach is emphasized.
... The recognition of the need for oxygen-permeable materials spurred advancements, resulting in lenses that greatly improved wearer comfort and acceptance, and minimized complication rates [48]. Today, contemporary scleral lenses utilize advanced gas-permeable materials, enabling the effective management of a wide array of conditions, from refractive errors to complex ocular surface diseases [56][57][58][59][60][61]. Traditionally, SLs were categorized based on their diameter relative to the visible horizontal iris diameter. ...
Article
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Corneal ectasias, including keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia, poses significant visual rehabilitation challenges due to the resultant irregular astigmatism, myopia, and higher-order aberrations (HOAs). These conditions often resist traditional corrective methods, necessitating advanced optical solutions. Scleral lenses (SLs) have emerged as a primary non-surgical option for managing these complex corneal irregularities. SLs form a smooth optical interface by forming a tear-filled chamber between the lens and the cornea, effectively mitigating HOAs and improving both high-contrast and low-contrast visual acuity (VA). This review evaluates the efficacy of SLs in enhancing VA and reducing aberrations in patients with corneal ectasia. It also explores the technological advancements in SLs, such as profilometry and wavefront-guided systems, which enable more precise and customized lens fittings by accurately mapping the eye’s surface and addressing specific visual aberrations. The current body of evidence demonstrates that custom SLs significantly improve visual outcomes across various ectatic conditions, offering superior performance compared to conventional correction methods. However, challenges such as the complexity of fitting and the need for precise alignment remain. Ongoing innovations in SL technology and customization are likely to further enhance their clinical utility, solidifying their role as an indispensable tool in the management of corneal ectasias.
... Stosowane są w tym przypadku zarówno soczewki miękkie, np. silikonowo-hydrożelowe [32], jak i skleralne [33], zaprojektowane w sposób pozwalający na utrzymanie przed powierzchnią rogówki rezerwuaru łez utrzymującego nawilżenie powierzchni oka. ...
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Amendment to the Regulation of Minister of Labour and Social Policy of 1 December 1998 on safety and occupational hygiene at positions equipped with display monitors, adopted on October 18th, 2023, entered the long-awaited by employees possibility of reimbursement for corrective contact lenses, adjusting the Polish legislation to European directive regulating working conditions with display screen equipment. Contact lenses in many cases of refractive errors can be an alternative to prescription glasses method of correcting the visual impairment. There are however many clinical conditions, in which contact lenses can provide a better corrective effect on visual acuity. The information contained in medical databases of articles and scientific journals (PubMed, Biblioteka Nauki), online publications (Lippincott Journals), books, applicable legal regulations (available in Internetowy System Aktów Prawnych) and guidelines published by organizations and associations (Nofer Institute of Occupational Medicine in Łódź, Occupational Safety and Health Administration, Tear Film & Ocular Surface Society) were analyzed, covering the discussed issues over the years 2000-2023. Non-correction or suboptimal correction of a refractive error can cause a wide variety of troublesome symptoms, such as eye pain, headache, double vision, balance disorders, nausea, disturbances in the perception of the surroundings, contributing to poorer work efficiency, faster fatigue or an increased risk of error. This article, which is a narrative review, aims to present these conditions, as well as provide a brief overview of the types of contact lenses used, complications that may result from their use and contraindications to the use of this type of correction. Med Pr Work Health Saf. 2024;75(4).
... A lens that rests entirely on the sclera is considered a scleral lens regardless of diameter. Regardless of the nomenclature used, there are many manufacturers and designs of scleral lenses [19]. ...
Article
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Purpose: Dry eye disease (DED) is a multifactorial condition significantly impacting patients’ quality of life (QoL). This study aims to present a case series highlighting the effectiveness of customized scleral lenses in managing severe DED and improving patient outcomes. Methods: This case series includes three patients with severe DED refractory to conventional treatments. Customized scleral lenses were fitted for each patient, and clinical outcomes were evaluated over a period of two months. Assessments included best-corrected visual acuity (BCVA), slit-lamp examination findings, and corneal National Eye Institute (NEI) scores. Results: All three patients demonstrated significant improvements in BCVA, reductions in ocular symptoms, and enhanced ocular surface health. Patient 1, with secondary Sjögren’s syndrome and suspected mucous membrane pemphigoid, showed resolution of conjunctival hyperemia and epithelial defects. Patient 2, with graft versus host disease, exhibited resolution of punctate keratitis and the absence of thread mucus. Patient 3, post-oncologic surgery, achieved complete resolution of keratoconjunctivitis sicca and the restoration of vision. Conclusions: Customized scleral lenses are a useful therapeutic option for severe DED, providing significant symptomatic relief and enhancing patients’ quality of life. Their use should be considered in refractory cases to optimize ocular surface health and visual outcomes.
... Two types of contact lenses are currently commonly used: soft scleral lenses and rigid gas permeable (RGP) lenses. Generally, RGP lenses are preferred over soft lenses in managing DED due to their superior durability and oxygen penetrability [99,100]. The fitting of a contact lens that is simple, fenestrated, and oxygen-permeable has a range of therapeutic, ocular surface disease-mitigating, and optical applications. ...
Article
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Dry eye disease (DED) is a continuing medical challenge, further worsened in the autoimmune inflammatory hyperactivation milieu of Sjögren’s syndrome (SS) due to disturbances to innate and adaptive immunity with malfunctioning neuro-endocrine control. However, the pathogenetic mechanisms of SS DED are not fully established. This review summarized the available evidence, from systematic reviews, meta-analyses, and randomized clinical trials, for the efficacy and safety of the available ocular therapeutics for the management of SS DED. Relevant studies were obtained from major databases using appropriate keywords. The available largely empirical symptomatic, supportive, and restorative treatments have significant limitations as they do not alter local and systemic disease progression. Topical therapies have expanded to include biologics, surgical approaches, scleral lens fitting, the management of lid margin disease, systemic treatments, nutritional support, and the transplantation of stem cells. They are not curative, as they cannot permanently restore the ocular surface’s homeostasis. These approaches are efficacious in the short term in most studies, with more significant variability in outcome measures among studies in the long term. This review offers an interdisciplinary perspective that enriches our understanding of SS DED. This updated review addresses current knowledge gaps and identifies promising areas for future research to overcome this medical challenge.
... 1,2 These lenses are widely used to improve visual acuity in eyes with chronic cicatrizing conjunctivitis (CCC) 3 secondary to Stevens-Johnson syndrome (SJS), 4-6 ocular mucous membrane pemphigoid (MMP), 7 ocular graft-vs-host disease (GVHD), 8,9 and chemical or thermal burns. 1,[10][11][12][13] In eyes with CCC and corneal scarring, owing to various degrees of coexistent dry eye disease (DED) or limbal stem cell deficiency (LSCD), optical penetrating keratoplasty may not be a feasible option. Hence, SCLs are a valuable and sustainable option for visual rehabilitation in these eyes. ...
Article
Purpose The aim of this study was to describe the importance of symblepharon release with ocular surface reconstruction (OSR) for optimal fitting of scleral contact lenses (SCLs) in eyes with chronic cicatrizing conjunctivitis (CCC) and keratopathy. Methods This retrospective study included 32 eyes with CCC and keratopathy with symblepharon which underwent symblepharon release with OSR and were fitted with SCLs. The primary outcome measure was the improvement in best-corrected visual acuity with SCL wear. Results A total of 32 eyes of 29 patients (66% men) with a median age of 30.5 years were included. The common causes of CCC were Stevens–Johnson syndrome (66%) and ocular burns (16%). The most common location of symblepharon was superior (59%) with limbal involvement in most eyes (94%). Symblepharon release was combined with mucous membrane grafting (63%), amniotic membrane grafting (31%), or conjunctival autografting (6%). The median interval between symblepharon release with OSR and SCL trial was 15 weeks [interquartile range (IQR): 6–24]. The median best-corrected visual acuity improved from logMAR 1.5 (IQR: 1.2–1.8) to logMAR 1.2 (IQR: 0.6–1.4) with SCLs after symblepharon release with OSR ( P < 0.001). The median diameter of the SCL used was 15 mm (IQR: 15–16), with a median base curve of 7.9 mm (IQR: 7.9–8). Symblepharon recurrence was noted in 70% of eyes that underwent amniotic membrane grafting; no recurrence was seen with mucous membrane grafting or conjunctival autografting. Conclusions In eyes with CCC with keratopathy and symblepharon, visual rehabilitation is possible with SCLs after symblepharon release with OSR without having to resort to a penetrating corneal procedure.
... Due to the breathable material and design, large-diameter RGPs are often used to treat keratoconus (KCN), high astigmatism that cannot be corrected with small-diameter rigid lenses, ocular surface diseases, and simple refractive correction [30][31][32] . They are also a preferred choice over soft contact lenses for their ability to provide tear storage between the lens and the cornea, offering relief from discomfort associated with dry eye syndrome (DES) 25,33 . ...
Article
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This study investigated the influence of large-diameter multifocal contact lenses on the ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes. The study enrolled 40–55-year-old adults with presbyopia and dry eye syndromes (DES). The subjects were randomly assigned to three groups wearing different designs of contact lenses (Proclear, SMR, and Optimum) for 6–8 h a day for two weeks. Ocular surface health, tear quality, visual quality, and visual function were measured before and after lens wear. No significant difference was observed across all three groups for the amount of conjunctival redness, blink frequency (lens on), and stereopsis vision before and after wearing. Although there seemed to be a significant declining trend for corneal staining and limbal redness, non-invasive tear break-up time (TBUT), and lipid layer thickness while lens wear, the measured values were all within the normal range. Vice-versa after lens removal, results also showed significant improvement on lipid layer thickness, blink frequency (lens off), and contact TBUT. A significant improvement was observed in the modulation transfer function (MTF) of the total area ratio after wearing contact lenses. In contrast, the MTF of the high-order aberration area ratio resulting from lens wear was lower than that of the baseline measurement. There are also significant improvements observed for SMR and Optimum regarding near visual acuity, near point of accommodation, and the subjective questionnaire (OSDI and VBP) scores. Although it is difficult to avoid a specific negative impact on the ocular surface and tear film, visual function and visual quality can still be positively improved, especially shown on larger diameter and distance-center designed multifocal contact lenses.
... At present, ScCLs may be used to improve and minimize the symptoms of dryness, acting as a therapeutic treatment for patients with dry eyes [21]. The development of dry eye after LASIK is one of the most common postoperative conditions following ophthalmic surgery [22]. ...
Article
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The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.
... Despite well-documented benefits of both soft and SL use for management of severe dry eye disease, their use is not generally recommended as early therapy. 22,29,30 Fewer than 15% of all respondents were using contact lenses as part of their management of dry eye disease in this study. The mean age of individuals using SLs was older than those using therapeutic soft lenses. ...
Article
Objectives To report patient-reported experiences with dry eye disease and therapeutic contact lenses. Methods A survey was distributed to patients with dry eye disease. Demographics, Ocular Surface Disease Index (OSDI), systemic disease, contact lens history, and burden of care information were collected. Descriptive statistics are presented and categorized by nonlens, soft lens, and scleral lens (SL) wearers. Results Of 639 respondents, 15% (94/639) were currently using therapeutic soft or SLs (47 soft and 69 SL). Mid-day fogging or clouding of vision was reported by SL (75%, 50/67) and soft lens (62%, 29/47) wearers. Seventy-two percent of SL wearers spent more than 20 min daily on dry eye treatment while 43% of soft lens wearers spent more than 20 min. Median annual expenditure was higher for SL ($1,500, n=63) than nonlens ($500, n=371) or soft lens wearers ($700, n=43). Mean OSDI scores in all groups were in the severe category (51±22 years, n=401 nonlens wearers; mean age; 45±22 years, n=47 soft lens wearers; 60±24 years, n=69 SL wearers). Conclusions Mid-day fogging and blurring of vision was reported by most of the individuals using therapeutic lenses for dry eye disease. SL wearers allocate the most resources for dry eye care.
... Dr. Frankel performed the scleral lenses fitting trial, but the patient, who had never worn contact lenses, did not tolerate them. Scleral lenses are usually very well tolerated, especially in cases of severe, refractory dry eye [12], but the reality is that having to wear contacts on a daily basis is not an easy task for anyone, especially for a patient that has never worn contacts before. Dr. Frankel thus decided to reinsert collagen punctal plugs, maintain topical cyclosporine A 0.05%, and do other short-term steroid (loteprednol) and antibiotic (azithromycin) cycles. ...
Article
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Dry eye disease is a very common condition, especially among aging women. People often think of it as a very mild and non-harmful issue, but the reality is that it has a huge deleterious effect on patients' quality of life. Most publications usually focus on the scientific aspects of this pathology: its epidemiology, diagnosis, or management. However, in this article we highlight the patient's perspective and the challenges of living with dry eye disease. With prior informed consent, we interviewed a patient whose life has drastically changed since she first got the diagnosis. We also asked healthcare professionals based in Miami who were involved in this patient's care for their opinions. We hope that the messages and commentaries resonate with patients and physicians involved in the care of dry eye disease worldwide.
... For removing inducements, a study found that contact lenses embedded with ceria nanoparticles can effectively remove reactive oxygen species and avoid DeD in high h 2 O 2 environment (choi et al., 2020). Moreover, scleral lenses can retain drugs during prolonged periods due to their tear film reservoir (lim et al., 2009;ciralsky et al., 2015;Polania-Baron et al., 2021), and have become a viable option to relieve the symptoms of dry eye syndrome (Bavinger et al., 2015;la Porta Weber et al., 2016;Marty et al., 2022). to alleviate ocular symptoms, White et al. fabricated a hydroxypropyl methylcellulose-loaded contact lens using molecular imprinting technology, which can continuously release hydroxypropyl methylcellulose for up to 60 days and effectively combat DeD caused by contact lens (White et al., 2011). ...
Article
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Traditional ophthalmic drugs, such as eye drops, gels and ointments, are accompanied by many problems, including low bioavailability and potential drug side effects. Innovative ophthalmic drug delivery systems have been proposed to overcome the limitations associated with traditional formulations. Recently, contact lens-based drug delivery systems have gained popularity owing to their advantages of sustained drug delivery, prolonged drug retention, improved bioavailability, and few drug side effects. Various methods have been successfully applied to drug-loaded contact lenses and prolonged the drug release time, such as chemical crosslinking, material embedding, molecular imprinting, colloidal nanoparticles, vitamin E modification, drug polymer film/coating, ion ligand polymerization systems, and supercritical fluid technology. Contact lens-based drug delivery systems play an important role in the treatment of multifarious ophthalmic diseases. This review discusses the latest developments in drug-loaded contact lenses for the treatment of ophthalmic diseases, including preparation methods, application in ophthalmic diseases and future prospects.
... [12] Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty prosthesis] and PROSE) in addressing the problems related to ocular discomfort, improving visual acuity and various ocular surface parameters such as Ocular Surface Disease Index (OSDI), visual function questionnaire 25 (VFQ-25), and National Eye Institute (NEI) grading in patients with various ocular surface diseases [ Table 3]. [1,[32][33][34][35][36][37][38][39][40][41][42][43][44] ...
Article
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Contact lens wear is useful in ocular conditions such as high refractive errors, irregular astigmatism, corneal ectasias, corneal dystrophies, post-keratoplasty, post-refractive surgeries, trauma, and ocular surface diseases. The new innovations of highly oxygen-permeable contact lens materials have broadened the applications of contact lens suitability. Therapeutic contact lenses are medically used in the management of a wide variety of corneal conditions and ocular surface diseases. These lenses aid in pain relief, enhance corneal healing, maintain ocular homeostasis, and act as a drug delivery system. Drug delivery applications of contact lenses hold promise for improving topical therapy. The modern rigid gas permeable scleral contact lens provides symptomatic relief in painful corneal diseases such as bullous keratopathy, corneal epithelial abrasions, and erosions. It has been useful in therapeutic management as well as visual rehabilitation by enhancing the ocular surface and protecting the cornea from adverse environmental conditions. This review provides a summary of contact lenses used for the treatment of ocular surface diseases based on the current evidence available in the literature. This can help enhance the understanding and management of ocular surface diseases with respect to contact lens use in our day-to-day ophthalmology practice.
... Bunga misol tarzida shox pardaning notekis yuzasi, birlamchi keratektaziya (keratokonus, marginal degeneratsiya va keratoglobus) va shox pardaning shikastlanishi yoki yallig'lanish kasalliklaridan keyingi holatlarni keltirish mumkin. Shuningdek, skleral linzalar ko'zning yuza kasalliklarida (shu jumladan yuqumli keratitda) va patologik holatlarida: quruq ko'z sindromi [3][4][5][6], Stivens-Jonson sindromi [7], Sho'gren [8], neyrotrofik keratopatiya [9], shuningdek, yuqori turli xil darajadagi refraksiya anomaliyalari, afakiya [1] holatlarida qo'llaniladi. M. M. Schornack (2011) tomonidan olib borilgan tadqiqotda progressiv limbal o'zak hujayralari yetishmovchiligi bo'lgan bemorlarni davolashda skleral linzalardan muvaffaqiyatli foydalanish to'g'risidagi ma'lumotlar taqdim etilgan bo'lib, bu limbal o'zak hujayralarini transplantatsiyasiga bo'lgan ehtiyojni va keyinchalik tizimli immunosupressiya xavfini sezilarli darajada kamaytiradi. ...
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Dolzarbligi. Ko’zning shox pardasi va oldingi segmenti patologiyasini davolashda skleral linzalarning terapevtik qo’llanilishi 1980‑yillarning oxiridan boshlab skleral linzalar shox parda patologiyasi, ko’zning oldingi segmenti kasalliklarini davolashda faol ishlatilgan. Skleral linzalar oddiy mahalliy tomchilardan shox parda va paralimbal epiteliyga ta’siri, uzoq muddatli gidratatsiya effekti bilan farq qiladi. Terapevtik tomondan skleral linzalar birdaniga ikkta vazifani ta’minlashi mumkin: ular ko’z yuzasini himoya qiladi va epiteliyning notekisligi mavjud bo’lgan kasallarda ko’rish o’tkirligini tiklaydi. Tadqiqot maqsadi. Mumkin bo'lgan jarrohlik aralashuvlarni kechiktirish imkonini beruvchi, shuningdek, yuqumli keratit va shox parda epiteliya nuqsonlarini davolashda shox parda patologiyasini davolashning mustaqil usuli sifatida skleral linzalarning samaradorligini aniqlash. Material va usullar. Maqolada ko’zning shox pardasi va oldingi segmenti patologiyasini davolashda skleral linzalarning terapevtik qo’llanilishiga oid masalalarni aks ettiruvchi 2013 yildan boshlab ohirgi xorijiy ilmiy nashrlar analizi qilindi. Natija. Skleral linzalarning uzluksiz gidratatsiyani ta’minlash qobiliyati, ko’z yuzasini namlash va himoya qilish, bemorlarga ko’rish o’tkirligini saqlashga imkon beradi va ularning terapiyaning boshqa shakllari bilan birgalikda qo’llash mumkin bo’lganligi ularni og’ir ko’z yuzasi kasalliklari uchun samarali davolash variantiga aylantiradi.
... Furthermore, advances in the geometry and manufacture of scleral and mini-scleral CLs have meant that it is now possible to manufacture spherical and toric CL with high ''Dk'' materials --the product of the diffusion coefficient (D) of the material and the solubility of oxygen (k) --, which allows the lenses to be worn for a long period of time [2]. In addition, scleral CLs also allow corneas to be bathed in preservative-free saline solution, which improves the symptoms of dry eye [3,4], a phenomenon that may be more prominent in patients with KC [5]. ...
... Scleral lenses have been shown in multiple studies to be effective therapy for even severe ocular surface disease. [28][29][30][31][32][33][34] Conclusions that can be drawn from this study are limited by constraints of survey research in general and by specific aspects of this survey design including potential order bias. With all survey research, the sample of individuals who respond may not accurately represent the views of the entire population surveyed. ...
Article
Objectives: To describe prescribing patterns of therapeutic scleral lenses (SLs) in the management of corneal irregularity and ocular surface disease among practitioners who prescribe SLs. Methods: Participants ranked treatment options for corneal irregularity and ocular surface disease in the order they would generally consider using them in an electronic survey. Median rank score for each option is reported, along with the percentage of participants assigning first place ranking to each option. The percentage of participants assigning first, second, or third place ranking to each option is also reported. Results: Seven hundred and seventy-eight practitioners participated. Scleral lenses are most frequently considered as the first choice for the management of corneal irregularity based on overall median rank, followed by corneal rigid lenses (rigid gas-permeable [RGPs]). Scleral lenses were the first choice of 42% of participants, followed by RGPs (20%). For ocular surface disease, lubricant drops are most frequently used first, followed by meibomian gland expression, topical cyclosporine or lifitegrast, topical steroids, punctal plugs, and SLs, respectively. Lubricant drops were the first therapeutic option considered for ocular surface disease by 63% of participants and 45% ranked SLs as their sixth, seventh or eighth treatment based on median overall rank. Conclusions: Scleral lenses were identified as the first option for management of corneal irregularity more frequently than RGPs. Scleral lenses are considered for management of ocular surface disease before surgical intervention but after meibomian gland expression, punctal occlusion, and topical medical therapy are attempted.
... В литературе можно насчитать более 50 патологий, в терапевтическом лечении которых применяются склеральные линзы [18,19]. Примером может служить иррегулярная роговичная поверхность, причем имеются в виду как первичные кератэктазии (кератоконус, маргинальная дегенерация и кератоглобус), так и состояния после вмешательств, травм или воспалительных заболеваний роговицы [19][20][21][22][23]. Также патологиями для назначения склеральных линз являются заболевания глазной поверхности (в том числе инфекционные кератиты) и патологические состояния глазной поверхности: синдром сухого глаза [24][25][26][27], синдром Стивенса -Джонсона [28], синдром Съегрена [29], нейротрофическая кератопатия [30], а также различные аномалии рефракции высокой степени, афакия [18]. H. Baratz опубликовали результаты исследования о роли склеральных линз в лечении глазного рубцового пемфигоида. ...
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This review focuses on the therapeutic use of scleral lenses in the treatment of corneal pathology described in the international scientific literature. The potential of scleral lenses in the treatment of pathology of the cornea and anterior segment of the eye has been studied since the late 1980s. The scleral lenses were actively used both in the treatment of corneal pathology and in the treatment of diseases of the anterior segment of the eye. The use of scleral lenses in the treatment of corneal pathology may promise an area for development for this treatment modality. Contrary to eye-drops, which remain on the ocular surface for a relatively short time, the scleral lenses provide a long-term hydration of the corneal epithelium and paralimbal conjunctiva. Tarsorrhaphy and other surgical interventions limit visual acuity and the field of vision and provide poor cosmetic results. The scleral lenses, however, can provide 2-in-1 therapy as they protect the ocular surface and, in case of epithelial roughness, may improve visual acuity in patients with ocular surface diseases. The ability of scleral lenses to provide a continuous hydration and protection of the ocular surface, allowing patients to maintain functional visual acuity, as well as their ability to be used in combination with other forms of therapy, makes them a valuable option for the treatment of severe ocular surface diseases. Incorporating scleral lenses into a combined, multidisciplinary approach to treatment can bring relief to patients without resorting to more invasive treatment options. Our analysis identified only a few studies on the use of scleral lenses in the treatment of corneal pathology, which is likely due to the complexity of customization of their fit. This indicates the need for scientific research aimed at developing universal scleral lenses for the treatment of the cornea based on the criteria of the radius of curvature and the diameter of the cornea of a healthy eye.
... Users insert a sterile solution into the lens before wearing it and the solution is held in place between the cornea and the lens creating a "liquid bandage." [30] Finally, customized PROSE prosthetic devices can be used that are created on a patient-by-patient basis with a custom-designed vault to treat severe OSD. ...
Article
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The evolution of refractive cataract surgery has increased patient expectations for visual outcomes following cataract surgery. Precise biometry and keratometry are critical for accurate intraocular lens (IOL) selection and favorable surgical outcomes. In patients with the ocular surface disease and corneal pathologies, preoperative measurements can often be erroneous, leading to postoperative refractive surprises and dissatisfied patients. Conditions such as dry eye disease, epithelial basement membrane dystrophy, Salzmann's nodular dystrophy, and pterygia need to be addressed thoroughly before performing cataract surgery to optimize the ocular surface, obtain high-quality preoperative measurements, and ultimately determine the appropriate IOLs. In this review, the various ocular surface pathologies affecting cataract surgery outcomes and options for treatment are discussed and the importance of optimization of the ocular surface before cataract surgery is reviewed.
... Por ejemplo, en pacientes con ojo seco acuo-deficiente o evaporativo, incluidos el síndrome de Sjögren, la enfermedad injerto-contra-huésped, la rosácea y la DGM grave, deben utilizarse gafas protectoras, sustitución protésica del ecosistema de la superficie ocular (PROSE) o lentes de contacto de bajo contenido en agua para limitar la exposición a las condiciones ambientales adversas. [100][101][102][103][104] Dispositivos Electrónicos Para pacientes con uso excesivo de dispositivos electrónicos con pantallas digitales, como computadoras, tabletas y teléfonos inteligentes, recomendamos aumentar la administración de lubricantes tópicos y aplicar la regla 20/20/20 (cada 20 minutos, apartar la vista de la pantalla y centrarla en algo situado a 20 pies de distancia durante 20 segundos) para relajar el reflejo de acomodación y reducir la fatiga visual. 105,106 Manejo de la Inflamación Palpebral El Panel Mexicano y otros han sugerido que la blefaritis anteriormente descrita y la DGM pueden tener lugar en cada fase de gravedad en pacientes con EOS. ...
Article
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La enfermedad del ojo seco (EOS) tiene una prevalencia mayor que muchas otras enfermedades sistémicas importantes, como las enfermedades cardiovasculares y la diabetes mellitus, y supone un importante menoscabo en la calidad de vida de los pacientes afectados. Es un motivo de consulta habitual en clínicas oftalmológicas en todo el mundo. Hoy en día, el diagnóstico y el enfoque terapéutico de los especialistas en córnea y superficie ocular deben reservarse para casos de ojo seco graves y crónicos asociados con enfermedades sistémicas autoinmunes o con patologías complicadas de la córnea y la superficie ocular. En dichos casos, el diagnóstico y el enfoque terapéutico suelen ser complejos, elaborados, prolongados y costosos, dado el uso de cuestionarios extensos sobre ojo seco, equipos de diagnóstico electrónico no invasivos y pruebas clínicas de laboratorio y auxiliares de diagnóstico. Más aún, otros especialistas en el cuidado ocular atienden un considerable número de casos de EOS, por lo que su diagnóstico, clasificación y manejo deberían ser algo sencillo, práctico, asequible y efectivo. Considerando que muchos pacientes que van a clínicas no especializadas para el tratamiento del ojo seco se beneficiarían de una mejor atención oftalmológica, hemos decidido elaborar un sistema práctico de clasificación de la EOS en base a su gravedad, para ayudar a los profesionales de la salud visual a discriminar los casos que precisen derivación de los pacientes a clínicas de alta especialidad. Además, proponemos un enfoque sistemático y consideraciones generales de manejo para mejorar los resultados terapéuticos de los pacientes en base a la gravedad de la enfermedad.
... However, the limitation is its availability, expense and need of training for its application and removal. [108][109][110] ...
Article
Background: Aqueous deficiency dry eye disease is a chronic and potentially sight-threatening condition, that occurs due to the dysfunction of the lacrimal glands. The aim of this review was to describe the various recent developments in the understanding, diagnosis and treatment of lacrimal gland insufficiency in aqueous deficiency dry eye disease. Methods: A MEDLINE database search using PubMed was performed using the keywords: "dry eye disease/syndrome", "aqueous deficient/deficiency dry eye disease", "lacrimal gland" and "Sjogren's syndrome". After scanning through 750 relevant abstracts, 73 eligible articles published in the English language from 2016 to 2021 were included in the review. Results: Histopathological and ultrastructural studies have revealed new insights into the pathogenesis of cicatrising conjunctivitis-induced aqueous deficiency, where the lacrimal gland acini remain uninvolved and retain their secretory property, while significant ultrastructural changes in the gland have been observed. Recent advances in diagnosis include the techniques of direct clinical assessment of the lacrimal gland morphology and secretion, tear film osmolarity, tear film lysozyme and lactoferrin levels, tear film interferometry and lacrimal gland confocal microscopy. Developments in the treatment of aqueous deficiency dry eye disease, apart from the nanoparticle-based tear substitutes, include secretagogues like diquafosol tetrasodium and rebamipide, anti-inflammatory topical agents like nanomicellar form of cyclosporine and lifitegrast, scleral contact lenses, neurostimulation, and acupuncture for increasing the amount of tear production, minor salivary gland transplantation, faecal microbial transplantation, lacrimal gland regeneration and mesenchymal stem cell therapy. Conclusions: Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade. Of which, translational breakthroughs in terms of newer drug formulations and regenerative medicine are most promising.
... For example, in patients with ADDE or EDE, including Sjögren syndrome, GvHD, rosacea or severe MGD, protective eyeglasses, prosthetic replacement of the ocular surface ecosystem (PROSE), or low-water content contact lenses should be used to limit exposure to adverse environmental conditions. [100][101][102][103][104] Electronic Devices For patients with excessive use of electronic devices with digital screens such as computers, tablets, and smartphones, we recommend increasing the administration of topical lubricants and applying the 20/20/20 rule (every 20 minutes, look away from the screen and focus the gaze on something at 20 feet for 20 seconds) to relax the accommodation reflex and reduce eye strain. 105,106 Management of Lid Inflammation The Mexican Panel and others suggested that anterior blepharitis and MGD may occur at every severity stage in DED patients. ...
Article
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Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity.
... In severe dry eye cases, the PROSE scleral contact lens may be used. 151 The PROSE consists of a custom-made prosthetic device used to mimic the impaired ocular surface functions upon corneal disease, including severe DED. Its principle of no corneal contact provides high oxygen permeability and protection against the lid shearing blinking forces, creating an adequate humid environment that enhances the corneal surfacés healing. ...
Article
Objectives Dry eye disease (DED) is arguably the most frequent ocular disease encountered in ophthalmic clinical practice. DED is frequently an underestimated condition causing a significant impact on visual function and quality of life. Many systemic autoimmune diseases (SAIDs) are related to moderate to severe DED. The main objective of this review is to enhance the awareness among ophthalmologists of the potential association of an underlying SAID in a high-risk patient with DED. Methods An exhaustive literature search was performed in the National Library of Medicine's Pubmed, Scopus, Web of Science, and Google Scholar databases for all English language articles published until November 2021. The main keywords included “dry eye disease” associated with autoimmune, connective tissue, endocrine, gastrointestinal, hematopoietic, vascular, and pulmonary diseases. Case reports, series, letters to the editor, reviews, and original articles were included. Results Although DED is frequently associated with SAIDs, its diagnosis is commonly delayed or missed, producing significant complications, including corneal ulceration, melting, scleritis, uveitis, and optic neuritis resulting in severe complications detrimental to visual function and quality of life. SAID should be suspected in a woman, 30 to 60 years old with a family history of autoimmunity, presenting with DED symptoms and extraocular manifestations including arthralgias, dry mouth, unexplained weight and hair loss, chronic fatigue, heat or cold intolerance, insomnia, and mood disorders. Conclusions Establishing the correct diagnosis and treatment of DED associated with SAIDs is crucial to avoid its significant burden and severe ocular complications.
... There are numerous case series that describe the successful management of dry eye patients, including those with Sjøgren syndrome, with fluid-ventilated scleral lenses [14,74,147,[262][263][264]. There is a single case report of polymicrobial and microbial keratitis in a Sjøgren patient in association with scleral lens use [265]. ...
Article
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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.
... By neutralizing optical aberrations, scleral lens can provide significant improvement in visual acuity for various irregular corneal conditions, such as severe keratoconus and postpenetrating keratoplasty [1][2][3][4] . Scleral lens can adequately retain tear reservoir between the posterior surface of the scleral lens and the cornea to efficaciously manage severe dry eye in a variety of chronic ocular surface diseases 1,[5][6][7][8][9] . Intractable ocular surface diseases are a collection of conditions with sustained ocular pain, permanent visual decrement due to persistent ocular inflammation, keratinization or conjunctivalization of the cornea and limbal stem cell deficiencies. ...
Article
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To report the efficacy and safety of large diameter scleral lenses and determine their suitability in Asian subjects with intractable ocular surface diseases. This prospective study enrolled intractable ocular surface diseases subjects with uncorrected visual acuity > counting finger but ≥ 0.3 logMAR and best-corrected visual acuity (BCVA) ≥ 0.3 logMAR, to fit large diameter scleral lenses for 12 weeks. 21 eyes (13 subjects) consisting ten eyes (47.6%) with persistent epithelial defects, 6 (28.6%) with graft-versus-host disease, 4 (19.0%) with Stevens–Johnson syndrome and one (4.8%) with severe dry eye were ultimately enrolled. Primary outcome measures were the visual acuity, corneal and conjunctival fluorescein staining, Ocular Surface Disease Index (OSDI), and National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). At week 12 with large diameter scleral lenses, BCVA improved from 0.77 logMAR to 0.27 logMAR ( P < 0.001). High-grade corneal and conjunctival fluorescein staining proportion decreased from 61.90 to 14.29% and 52.38 to 9.52%, respectively ( P = 0.0036 and 0.0063, respectively). OSDI and NEI-VFQ-25 improved from 67.89 to 34.69 and 51.40 to 64.48, respectively ( P < 0.001). No adverse effects were observed. In Asians with intractable ocular surface diseases, large diameter scleral lens improves visual acuity and alleviates signs and symptoms of ocular surface diseases without any significant complications. Trial registration Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Project No. HI12C0015 (A120018)). Clinical Trials.gov, NCT04535388. Registered 18 August 2020—Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04535388 .
... In progressive causes of DED generally seen with autoimmune pathologies, aggressive intensive IMT in acute phases followed by long term maintenance therapy can help limit disease progression. In addition to medical therapy, the use of scleral lenses such as prosthetic replacement of ocular surface ecosystem (PROSE) lenses helps relieve the symptoms, stabilizing the surface and visual rehabilitation of these patients [66]. ...
Article
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Dry eye disease (DED) is an emerging health concern causing significant visual, psychological, social, and economic impact globally. In contrast to visual rehabilitation undertaken at late stages of DED, measures instituted to prevent its onset, establishment, or progression can alter its natural course and effectively bring down the associated morbidity. This review attempts to present the available literature on preventive strategies of DED at one place, including strategies for risk assessment and mitigation, targeting a wide range of population. A literature search was conducted using PubMed and an extensive literature review on preventive strategies for DED was compiled to put forth a holistic and strategic approach for preventing DED. This can be undertaken at various stages or severity of DED directed at different tiers of the health care system. Conclusion: This review intends to put emphasis on preventive strategies being adopted as an integral part of routine clinical practice by general ophthalmologists and specialists to tackle the burden of DED and improve the quality of the lives of the patients suffering from it.
... There are numerous studies and clinical examples suggesting the safety and efficacy of scleral lenses in the treatment of diseases such as dry eye syndrome (DES) of various severity [6][7][8], Stevens-Johnson syndrome [9], Sjogren's disease [10], and neurotrophic keratopathy [11]. Scleral lenses are also successfully used to treat persistent corneal epithelial defects [12]. ...
Article
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Background. Scleral lenses, due to their benefits, hold a specific position among all types of contact lenses. Some years ago, they began to be used successfully not only for the correction of complex types of refractive errors, when other types of correction failed to achieve satisfactory visual function and visual rehabilitation of patients, but also as a therapeutic system in the management of ocular surface disease. Purpose. To evaluate the efficacy of rigid gas permeable miniscleral contact lenses as a therapeutic system in the management of patients with dry eye syndrome by filling the space under the lens with a non-preserved sodium hyaluronate solution. Materials and methods. In the study, 7 patients (11 eyes) with keratectasias after corneal surgery and concomitant dry eye syndrome were included. In the treatment and rehabilitation of these patients, miniscleral contact lenses were used during daytime with additional filling of the space under the lens with a non-preserved sodium hyaluronate solution. Results. As a criterion of the effectiveness of miniscleral contact lens use for therapeutic purposes, along with a significant increase in visual function in patients with complex corneal pathology, the elimination of discomfort due to restoration of the corneal epithelium integrity and improvement of their quality of life is considered.
... They began regaining popularity as new technology and lens materials increased their gas-permeability and a variety of ocular surface diseases that could not be treated by soft contact lenses showed benefit from SCLs. 2 SCLs allow for the maintenance of a fluid reservoir between their posterior surface and the anterior surface of the cornea, providing both improved lubrication and refraction. 3 In addition to correcting corneal astigmatism, SCLs have successfully treated a variety of diseases of the ocular surface including keratoconus and ectatic disorders, severe astigmatism, Stevens-Johnson syndrome, microphthalmia, and severe dry, especially after soft lenses and punctal occlusion have failed. ...
Article
Full-text available
Purpose: Scleral contact lenses (SCLs) are devices that allow a fluid reservoir between the contact lens and the cornea, providing both improved lubrication and refraction. Consequently, SCLs have been used for significant refractive error in addition to a wide range of ocular surface diseases. We present the first case of a woman who complained of severe dryness and pain following resection of an adenoid cystic carcinoma of her lacrimal gland with complete resolution of her symptoms with a SCL. Observations: A woman who complained of severe dryness and pain following resection of an adenoid cystic carcinoma of her lacrimal gland presented to the ophthalmology clinic. She had no subsequent lacrimal function without relief from conventional dry eye treatments. However, early treatment with a SCL successfully preserved her ocular surface, improved her corneal staining pattern, and improved her vision. Conclusions and importance: While other options exist, including permanent tarsorrhaphy, lid taping, or moisture goggles, the SCL allowed the combination of cosmesis, visual function, and ocular surface rehabilitation.
... Estos componentes favorecen la reparación epitelial y el mantenimiento de la homeostasis de la superficie ocular. Otra estrategia posible en casos de ojo seco grave es el uso de lentes de contacto escleral PRO-SE (Prosthetic Replacement of the Ocular Surface Ecosystem) 61 . El uso de tapones de puncta lagrimales es controversial, y generalmente no se recomienda en el SS debido a que la acumulación de citocinas y metaloproteasas en la lágrima induce mayor inflamación de la superficie ocular 56 . ...
Chapter
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El síndrome de ojo seco es un trastorno multifactorial que suele ir acompañado de diversas enfermedades sistémicas. Entre otros trastornos congénitos, destacan la alácrima, la displasia ectodérmica anhidrótica, el síndrome de displasia ectodérmica, ectrodactilia y paladar hendido y el síndrome de Riley-Day, entre otras. Enfermedades dermatooculares como la rosácea, el penfigoide de membranas mucosas, la epidermólisis bullosa, el eritema multiforme mayor, la necrólisis epidérmica tóxica y la enfermedad injerto-contra-huésped. Además de enfermedades más frecuentes de origen autoinmune como los trastornos endocrinos: diabetes mellitus y disfunción tiroidea (hipotiroidismo, enfermedad de Graves y tiroiditis de Hashimoto), así como enfermedades vasculares del colágeno como el SS1, la artritis reuma-toide (AR), el lupus eritematoso sistémico (LES) y la esclerosis sistémica progresiva (ESP), entre otras. Estas últimas enfermedades serán las que discutiremos en este capítulo.
... It is crucial that patients understand the application and removal process and are trained in handling ScCL as patients may have initial difficulty with this process. 13 Hygiene and compliance are also fundamental in preventing the development of infections. 14 This paper will discuss ScCL problems related to handling, care, and compliance. ...
Article
Full-text available
Scleral contact lens (ScCL) handling may be challenging and is the principle reason for ScCL drop out. ScCL care systems are more intricate than other lens modalities and include solutions for cleaning, disinfection, storing, rinsing and filling the lens; respecting the use of each solution recommended is fundamental. Replacement of the lenses, solutions, case and plungers are important in order to decrease the risk of adverse events associated with ScCL wear. Compliance is crucial regarding hygiene, solution use, case and plunger care, wear time, follow-up schedule, and handling techniques. Non-compliance may lead to discontinuation of ScCL due to difficulties associated with this unique lens design. This paper presents complications secondary to handling, care and compliance that clinicians and patients may encounter while wearing ScCL. Instructions are provided to enhance the understanding on management surrounding these issues. This manuscript includes three tables to summarize types of complications, their symptoms, clinical signs, etiology, and management for a quick find index for easy consultation during daily clinical practice.
Article
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Graft-versus-Host disease is a major complication of allogeneic stem cell transplantation. The eyes are a frequently affected organ with a severe dry eye disease being the hallmark manifestation. This retrospective study evaluates the effect of mini-scleral contact lenses on visual acuity, eye-related quality of life and the ocular surface. 62 eyes of 31 patients were included and visual acuity, ocular surface disease index (OSDI) questionnaire results and Oxford grades before and after mini-scleral lens fitting were compared. Median Snellen fraction with mini-scleral lenses was 20/25 (1st 20/30/3rd 20/20) compared to 20/40 median Snellen fraction with spectacles (1st 20/60/3rd 20/25). Median OSDI scores improved from 73 (1st 41.6/3rd 89) before fitting to 27 (1st 14.5/3rd 56) with mini-scleral lenses. Median Oxford grade decreased from 3 before mini-scleral lens fitting (1st 1/3rd 4.75) to 1 after mini-scleral lens fitting (1st 0/3rd 4). Median time of follow up was 717.5 days. Seven patients (22.6%) discontinued therapy with mini-scleral lenses. Mini-scleral lenses are beneficial for most patients with ocular GvHD as they improve visual acuity, eye-related quality of life and the integrity of the corneal epithelium.
Article
SIGNIFICANCE The tear meniscus height (TMH) along the lid margin is a clinical measure in the evaluation of patients with dry eyes and contact lens wearers. The morphology of the eyelid may differ among ethnic groups, potentially impacting the meniscus height, which can be useful for clinicians to optimize patient care. PURPOSE The central lower TMH is used as a clinical measure of tear volume in the assessment of contact lens candidates and patients with dry eyes. Ethnic differences in eyelid morphology may influence the measurement of the TMH. Furthermore, with the advent of larger contact lenses, such as scleral lenses, it would be of clinical value to assess the TMH centrally and peripherally. The purpose of this study was to evaluate and compare the TMH at different positions along the palpebral margin between Caucasian and Asian eyes. METHODS This prospective study evaluated the lower TMH in five positions (central, temporal and nasal limbus and temporal and nasal periphery) of the right eye using the Keratograph 5M (Oculus) instrument in Caucasian and Asian participants between 10 am and 12 pm . The TMH at each position was taken three times and averaged and analyzed using a 5 × 2 repeated-measures analysis of variance. RESULTS Central TMH did not differ significantly ( F = 0.02, p=0.88) in Caucasians (n = 20, aged 24.45 [2.30] years, TMH 0.320 [0.052] mm) and Asians (n = 20, aged 22.25 [3.43] years, TMH 0.325 [0.048] mm). A difference was noted with respect to TMH positions along the lid margin ( F = 64.17, p<0.001), independent of ethnicity ( F = 2.15, p=0.15). A post hoc analysis revealed a significantly higher TMH temporally when compared with centrally or nasally (p<0.001). CONCLUSIONS This study demonstrated the similarity of the central TMH and the differences in the peripheral TMH within Caucasian and Asian eyes. This may be clinically relevant when using the Tear Film & Ocular Surface Society Dry Eye Workshop II diagnostic algorithm for dry eyes and when fitting scleral contact lenses. Future studies need to consider that ethnic differences may exist for certain tests in order to personalize the care and management of each patient.
Article
Scleral lenses lies on the sclera, not the cornea, and help to improve vision in cases of irregular cornea or ocular surface diseases, and to treat ocular surface diseases with moisture to the cornea. The fitting rate of scleral lenses is increasing due to improvements in scleral lens materials and advancements in anterior segment imaging equipment. In order to successfully fit scleral lenses, it needs to understand the structure and principles of scleral lenses and select appropriate patients. There is no absolute contraindication of scleral lenses, but regular follow‐up is recommended for patients who require caution.
Article
Graft‐versus‐host disease (GVHD) is a systemic disease that can affect multiple organs as a consequence of an allogeneic haematopoietic stem cell transplant. One organ system that is often affected in GVHD is the eyes. Ocular GVHD (oGVHD) may involve various structures within the eye including the lacrimal glands, eyelids, conjunctiva, cornea, and nasolacrimal ducts, and is a source of morbidity in patients with GVHD. Common presenting features of GVHD overlap with dry eye disease (DED), including decreased tear production, epithelial disruption, and Meibomian gland dysfunction (MGD). In this review, we aim to compare oGVHD and DED to better understand the similarities and differences between the conditions, with a focus on pathophysiology, risk factors, clinical features, and treatments.
Article
Cataract surgery, which is the most widely performed ophthalmic procedure, is usually done in the elderly population, who are also prone to ocular surface disorders. Ocular surface diseases are multifactorial in nature and associated with symptoms and signs such as foreign body sensation, burning, fatigue, photophobia, red or watery eyes, or reduced visual acuity. These include a spectrum of conditions that may be immune or non-immune in nature. Cataract surgery in itself is known to alter the normal ocular surface milieu and cause tear film disturbances which can last up to 6 months post-operatively. These symptoms can be exaggerated in patients with ocular surface diseases. The planning and execution of cataract surgery can also be difficult in patients with associated ocular surface diseases. In this review, we discuss the various aspects of planning and intraoperative modifications to optimize the outcomes of cataract surgery in patients with ocular surface diseases.
Chapter
Managing patients with Sjögren’s syndrome (SS) in a clinical setting remains challenging despite a number of published practical management guidelines based on systematic reviews and involving both experts and patients. In this chapter we aim to provide a pragmatic guide to managing SS patients in clinic, drawing on evidence presented in this book, published guidelines, and the authors personal experience. Successful management of SS requires the physician to personalize care to the individual patient. Although dryness (sicca) of the eyes and mouth are the classically described features of SS, other mucosal surfaces may be affected, and patients may have systemic manifestations, including fatigue and arthralgia. Physicians should educate and support patients to manage their condition with interventions to conserve, replace, and stimulate secretions; prevent damage; and suppress any systemic disease activity.
Chapter
Sjögren’s syndrome dry eye is a complex disease. Three pathogenic factors are usually present at different levels of severity. These factors are tear instability, epithelial malfunction, and inflammation. Two additional factors, meibomian gland dysfunction and nerve dysfunction, may play a significant role. A successful therapeutic approach must correct each of these individual components, promoting the restoration of normal ocular surface homeostasis. This may involve the simultaneous use of different tools according to the clinical presentation, such as tear substitutes, anti-inflammatory drugs (steroids, cyclosporine A, Omega-3 fatty acids, etc.), epithelium protectants, and growth factor rich blood derivatives, bandage contact lenses, punctal plugs, and secretagogues.
Article
Objectives: To examine the relationship between central lens thickness and central corneal edema during short-term closed eye scleral lens wear. Methods: Nine participants (mean age 30 years) with normal corneas wore scleral lenses (Dk 141) under closed eye conditions on separate days with nominal center thicknesses of 150, 300, 600, and 1,200 μm. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography immediately after lens application and after 90 min of wear, before lens removal. Data were corrected for variations in initial fluid reservoir thickness and compared with predictions from theoretical modeling of overnight scleral lens wear. Results: Scleral lens-induced central corneal edema was primarily stromal in nature. The mean±standard error of corrected total corneal edema was 4.31%±0.32%, 4.55%±0.42%, 4.92%±0.50%, and 4.83%±0.22% for the 150-, 300-, 600-, and 1,200-μm lenses, respectively. No significant differences in the corrected total corneal edema were observed across all thickness groups (P=0.20). Theoretical modeling of overnight scleral lens wear seemed to overestimate the relative increase in central corneal edema as a function of decreasing lens Dk/t for values lower than 25. Conclusion: The magnitude of scleral lens-induced central corneal edema during short-term closed eye lens wear did not vary significantly with increasing central lens thickness. Theoretical modeling of overnight closed eye scleral lens wear seems to overestimate the effect of increasing lens thickness.
Article
Purpose The current paradigm for therapy of recalcitrant ocular surface diseases (OSD) consists of a sequential, step-up treatment approach. A combinatorial topical therapy (anti-inflammatory/immunosuppressive [steroid] with immunomodulatory [pooled human immune globulin] and tear substitute [serum]) that simultaneously targets several immunological pathways may be more efficacious. This report evaluates if the combinatorial therapy resulted in clinical benefit in patients with recalcitrant OSD. Methods We performed a retrospective case study of patients receiving topical, preservative-free, compounded formulations of steroids, pooled human immune globulin, and serum tears. Outcome measures included visual acuity, ocular surface disease index (OSDI), ocular discomfort score, subjective global assessment (SGA), corneal staining, conjunctival redness, and slit lamp photographs. Results Patients consisted of one male and 11 females ranging in age from 27 to 87 years old. Pathologies included ocular graft-versus-host disease (n = 4), Sjögren's syndrome (n = 3), ocular cicatricial pemphigoid (n = 1), pemphigus vulgaris (n = 1), peripheral ulcerative keratitis (n = 1), Stevens-Johnson syndrome (n = 1), and giant papillary conjunctivitis (n = 1). All patients were “improved” or “much improved” on SGA after combinatorial therapy. There was a clinically meaningful reduction in OSDI, ocular discomfort, corneal staining, and conjunctival injection. Additionally, three patients had improvement in their visual acuity (one from 20/400 to 20/20). Adverse effects included increased intraocular pressure in two patients, presumably due to topical steroid use. Conclusions Combinatorial therapy provides clinical benefit by reducing the symptoms and signs in recalcitrant OSD. Our study provides the rationale for performing prospective clinical trials to evaluate the efficacy of combinatorial therapy for treating recalcitrant OSD.
Article
SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5–10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.
Article
Significance: Scleral lenses (SLs) are increasing in scope, and understanding their ocular health impact is imperative. The unique fit of an SL raises concern that the landing zone causes compression of conjunctival tissue that can lead to resistance of aqueous humor outflow and increased intraocular pressure (IOP). Purpose: This study aimed to assess changes in optic nerve head morphology as an indirect assessment of IOP and evaluate other IOP assessment methods during SL wear. Methods: Twenty-six healthy adults wore SL on one randomly selected eye for 6 hours, whereas the fellow eye served as a control. Global minimum rim width (optical coherence tomography) and IOP (Icare, Diaton) were measured at baseline, 2 and 6 hours after SL application, and again after SL removal. Central corneal thickness, anterior chamber depth, and fluid reservoir depth were monitored. Results: Minimum rim width thinning was observed in the test (-8 μm; 95% confidence interval [CI], -11 to -6 μm) and control (-6 μm; 95% CI, -9 to -3 μm) eyes after 6 hours of SL wear (P < .01), although the magnitude of thinning was not significantly greater in the lens-wearing eyes (P = .09). Mean IOP (Icare) significantly increased +2 mmHg (95% CI, +1 to +3 mmHg) in the test eyes (P = .002), with no change in the control eyes. Mean IOP changes with Diaton were +0.3 mmHg (95% CI, -0.9 to +3.2 mmHg) in the test eyes and +0.4 mmHg (95% CI, -0.8 to +1.7 mmHg) in the control eyes. However, Diaton tonometry showed poor within-subject variation and poor correlation with Icare. No clinically significant changes were observed in central corneal thickness or anterior chamber depth. Conclusions: This study suggests that SLs have a minimal effect on IOP homeostasis in the normal eye during SL wear and an insignificant impact on the optic nerve head morphology in healthy adult eyes.
Article
Purpose To examine the relationship between central post-lens fluid reservoir thickness and central corneal oedema during short-term closed eye scleral lens wear, and to compare these empirical oedema measurements with open eye lens wear data and current theoretical modelling for overnight scleral lens wear. Methods Ten participants (mean ± standard error 30 ± 1 years) with normal corneas wore scleral lenses (Dk 141 × 10⁻¹¹ cm³ O2(cm)/[(sec.)(cm²)(mmHg)) under closed eye conditions on separate days with an initial central post-lens fluid reservoir thickness considered to be low (160 ± 7 μm), medium (494 ± 17 μm), or high (716 ± 16 μm). Epithelial, stromal, and total corneal oedema were measured using high-resolution optical coherence tomography immediately after lens application and following 90 min of wear, prior to lens removal. Data were compared to open eye scleral lens induced corneal oedema and a theoretical model of overnight closed eye scleral lens wear (Kim et al., 2018). Results Central corneal oedema was primarily stromal in nature and increased with increasing fluid reservoir thickness; the mean total corneal oedema was 3.86 ± 0.50%, 4.71 ± 0.28% and 5.04 ± 0.42% for the low, medium, and high thickness conditions, respectively. A significant difference in stromal and total corneal oedema was observed between the low and high fluid reservoir thickness conditions only (both p ≤ 0.01). Theoretical modelling overestimated the magnitude of central corneal oedema and the influence of fluid reservoir thickness upon corneal oedema during closed eye conditions. Conclusion Scleral lens induced central corneal oedema during closed eye lens wear increases with increasing fluid reservoir thickness, but at a decreased rate compared to theoretical modelling.
Article
Purpose: The aim of this study was to evaluate the anterior surface of scleral contact lens and ocular surface wettability before and after one-month of scleral lens wear in patients with keratoconus. Methods: Forty-nine patients with keratoconus (36.26 ± 9.03 years) were recruited. The sample was divided into two groups: patients with intrastromal corneal ring (KCICRS group) and patients without ICRS (KC group). TFSQ, Schirmer I test, Ocular Surface Disease Index (OSDI questionnaire), tear break-up time (TBUT) and corneal staining were evaluated in two different visits: Baseline (before lens wear) and one-month visit (10 min after lens removal). Visual Analog Scale (VAS questionnaire) was filled in just after inserting the lenses and just before removing them. TFSQ mean and inferior were evaluated over the contact lens surface at the moment of inserting the lens (baseline visit) and after 8 h of lens wear (one-month visit). Results: Anterior corneal surface TFSQ values increased in all groups after scleral lens wear (p < 0.05). However, there were no statistical differences found at the moment of inserting or after 8 h of lens wear on previous contact lens surface TFSQ (p > 0.05). No changes were found in tear volume for total and in KC and KCICRS groups (p > 0.05). For all groups, there was a statistical decrease of TBUT (p < 0.05). In addition, OSDI score, corneal staining and VAS score improved after scleral lens wear from baseline in total and in both KC and KCICRS groups (p < 0.05). Conclusion: The scleral contact lens surface keeps its wettability after one-month of wear. However, the wettability of the ocular surface is worse after contact lens wearing.
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Temperature variation is a ubiquitous medical sign to monitor ocular conditions including dry eye disease (DED), glaucoma, carotid artery stenosis, diabetic retinopathy, and vascular neuritis. The ability to measure OST in real time is desirable in point-of-care diagnostics. Here, we developed minimally invasive contact lens temperature sensors for continuous monitoring of the corneal temperature. The contact lens sensor consisted of a laser patterned commercial contact lens embedding temperature-sensitive Cholesteric Liquid Crystals (CLCs), which exhibited a fully reversible temperature-dependent color change in the visible spectrum. The contact lens allowed the corneal temperature to be mapped in four key areas, at distances of 0.0, 1.0, 3.0, and 5.0 mm from the pupil's edge. Liquid crystals exhibited a wavelength shift from 738 AE 4 nm to 474 AE 4 nm upon increasing the temperature from 29.0 C to 40.0 C, with a time responsivity of 490 ms and a negligible hysteresis. Readouts were performed using a smartphone, which output RGB triplets associated to temperature values. Contact lens sensors based on CLCs were fitted and tested on an ex vivo porcine eye and readouts were compared with infrared thermal measurements, resulting in an average difference of 0.3 C.
Article
Research and reviews have resulted in clear indications for scleral lens (SL) wear. Those indications include visual rehabilitation; therapeutic use in managing ocular surface diseases, lid and orbit disorders; and refractive correction to enhance visual quality, comfort and quality of life. In some cases, the use of SLs may be contraindicated: the presence of low endothelial cell density; Fuchs’ endothelial corneal dystrophy; glaucoma (because of the risk of an increase in intraocular pressure and the existence and location of draining devices and blebs); or overnight wear. While the literature provides an extensive description of the indications for scleral lens wear, the authors recognize that there is no paper reporting the contraindications to their use. The aim of this review is to illustrate the conditions for which SL wear is potentially contraindicated or requires caution. Improved knowledge of SL limits should reduce the risk of adverse events and increase the likelihood of fitting success.
Article
Purpose: To report the therapeutic effect of corneoscleral contact lenses (CLs) with a diameter of 14.0 mm on the refractory ocular surface diseases. Methods: Medical records of 13 eyes (of nine patients) attempted for fitting with corneoscleral CLs for the management of the severe refractory ocular surface diseases were retrospectively reviewed including Stevens-Johnson syndrome (SJS; eight eyes) and chronic ocular graft-versus-host disease (GVHD; five eyes). Lenses were fitted to improve refractory punctate epithelial erosions (PEE, ten eyes) and persistent epithelial defect (PED, three eyes with SJS) despite the proper medical management. Short-term (1 month) and long-term (12 months) changes in the best corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, mean wearing time, and National Eye Institute's Visual Function Questionnaire-25 (VFQ-25) were evaluated. Results: Of the 13 eyes, ten eyes were successfully fitted with the corneoscleral CLs. The fitting was failed in three eyes due to small palpebral fissure and shortened fornices (two eyes) and handling difficulty (one eye). At one-month follow-up after successful fitting in ten eyes, mean wearing time was 12.6 h (6.5-17, all day long) and BCVA improved from 0.56 ± 0.59 to 0.27 ± 0.46 in logMAR (P = .018). For the eight well-fitted eyes with refractory PEE, CFS score improved from 7.38±2.20 to 5.13±2.48 (P = .024). PED improved in all two eyes which were successfully fitted with corneoscleral CLs (Of the three eyes with PED, one eye failed fitting). At 12-month follow-up, mean wearing time was 11.4 h and the improved BCVA and CFS score were maintained. Furthermore, no adverse events attributable to corneoscleral CLs use occurred. Conclusion: The corneoscleral CLs with a diameter of 14.0 mm were successfully fitted in ten out of 13 eyes with severe refractory ocular surface diseases and demonstrated therapeutic benefits in the well-fitted eyes. The corneoscleral CL can be an option in the management of severe refractory ocular surface diseases.
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This opening chapter describes the evaluation and management of three patients with increasing severity of aqueous-deficient dry eye disease (AD-DED) (the management of meibomian gland disease, which frequently coexists with aqueous deficiency, is discussed in Chap. 2). The diagnosis and management of these three cases follows the Dry Eye Workshop (DEWS) recommendation which is based on the severity levels (Table 1.1). In Case 1, with mild dry eye disease (severity level 1), the emphasis is on proper history and counseling with lifestyle modifications. Case 2, with more moderate disease (severity level 2), highlights the use of anti-inflammatory therapy and the option of punctal plugs. Case 3, with more severe disease (severity level 3), discusses the advanced treatment options including total punctal occlusion, serum tears, and scleral lenses.
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To present a comprehensive review of current and historical literature on scleral lenses. A comprehensive search of several databases from each database's earliest inception to May 23, 2014 was conducted by an experienced librarian with input from the author to locate articles related to scleral lens design, fabrication, prescription, and management. A total of 899 references were identified, 184 of which were directly related to scleral lenses. References of interest were organized by date, topic, and study design. Most of articles published before 1983 presented lens design and fabrication techniques or indications for scleral lens therapy. Case reviews published after 1983 identified major indications for scleral lenses (corneal ectasia, ocular surface disease, and refractive error) and visual and functional outcomes of scleral lens wear. Statistically significant improvements in visual acuity, vision-related quality of life, and ocular surface integrity were reported. Reviews of ocular and systemic conditions suggested that comprehensive management strategies for these conditions could include scleral lenses. Early work investigating scleral lens fitting characteristics, optical qualities, and potential physiological impact on anterior ocular structures have been published in the past 5 years. Indications for scleral lens wear are well-established. Developing areas of research on the physiologic impact of scleral lens wear on the ocular surface, the use of technology to improve scleral lens vision and fit, and the impact of these devices on the quality of life should further enhance our understanding of scleral lenses in the future.
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Purpose To evaluate the use of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens treatment as an alternative to keratectomy in patients with symptomatic Salzmann’s nodular degeneration (SND). Methods A retrospective chart review from July 2009 to May 2013 identified 9 SND patients who were referred for PROSE evaluation. Patients who did not complete PROSE fitting or had other corneal comorbidities affecting vision were excluded from the study, and 7 eyes of 4 patients were included. Three patients were pseudophakic and 1 patient was phakic, and the lens status of our cohort did not change during the study. Results Visual acuity improved from 0.19 ± 0.084 logMAR (approximately 20/31) pre PROSE to 0.028 ± 0.047 logMAR (approximately 20/21) post PROSE in patients with Salzmann’s nodular degeneration (p = 0.002). OSDI scores improved from 46.9 ± 26.6 pre PROSE to 21.5 ± 18.7 post PROSE in the same cohort (p = 0.02). Conclusion The results of this study show that PROSE can provide improvements in visual acuity and function in patients with Salzmann’s nodular degeneration and offer an alternative to superficial keratectomy.
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Patients with Graves’ ophthalmopathy can be very challenging to manage secondary to the complex nature of their disease presentation. Patients may present with a variety of ocular findings including: lid retraction, periorbital and lid swelling, chemosis, conjunctival hyperemia, proptosis, optic neuropathy, restrictive myopathy, exposure keratopathy and/or keratoconjunctivitis sicca. Mini-scleral and scleral lens designs have been important in the management of irregular and regular corneas, and in the therapy of ocular surface diseases. We present here the case of a 48-year-old Caucasian male who had been diagnosed with Graves’ ophthalmopathy 13 years earlier. With significant ocular surface staining and over ten diopters of astigmatism, the patient had never been able to wear contact lenses comfortably. After being fit with the Mini-Scleral Design™ lenses, his vision improved to 20/25 OU, his ocular surface improved, and overall quality of vision increased.
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Purpose To describe the management of ocular surface disease with commercially available scleral lenses. Design Retrospective case series at a tertiary referral center. Participants A total of 212 patients (346 eyes) who were evaluated for scleral lens therapy for the management of ocular surface disease between June 1, 2006, and November 30, 2011. Methods Retrospective review of medical records and analysis of a survey mailed to all patients who completed the scleral lens fitting process to evaluate the long-term success of scleral lens therapy in the management of ocular surface disease. Main Outcome Measures Therapeutic outcome of scleral lens therapy, improvement in visual acuity with scleral lenses, indications for scleral lens wear, and efficiency of fitting process. Results Of the 212 subjects, 115 (188 eyes) successfully completed the scleral lens fitting process, and therapeutic goals (improved comfort, ocular surface protection, or resolution of keratopathy) were achieved in all but 2 of these subjects. Visual acuity improved with scleral lens wear, from 0.32±0.37 logarithm of the minimal angle of resolution (logMAR) (mean ± standard deviation; Snellen equivalent, 20/42) with habitual correction to 0.12±0.19 logMAR (Snellen equivalent, 20/26) with scleral lenses (P < 0.001). The most common indications for scleral lens therapy were undifferentiated ocular surface disease, exposure keratopathy, and neurotrophic keratopathy. Subjects had attempted an average of 3.2 (range, 0–8) other forms of intervention before scleral lens wear. Scleral lens fitting was completed in an average of 3 visits (range, 2–6), with an average of 1.4 lenses/eye (range, 1–4). Three patients experienced complications during scleral lens wear that resolved without loss of visual acuity, enabling resumption of scleral lens wear. Conclusions Commercially available scleral lenses can be successfully used in the management of moderate to severe ocular surface disease. The scleral lens fitting process can be completed efficiently for most eyes by using diagnostic trial lenses. In addition to protecting the ocular surface, scleral lenses improve visual acuity in patients whose surface disease has compromised vision.
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Scleral contact lenses (ScCL) have gained renewed interest during the last decade. Originally, they were primarily used for severely compromised eyes. Corneal ectasia and exposure conditions were the primary indications. However, the indication range of ScCL in contact lens practices seems to be expanding, and it now increasingly includes less severe and even non-compromised eyes, too. All lenses that partly or entirely rest on the sclera are included under the name ScCL in this paper; although the Scleral Lens Education Society recommends further classification. When a lens partly rests on the cornea (centrally or peripherally) and partly on the sclera, it is called a corneo-scleral lens. A lens that rests entirely on the sclera is classified as a scleral lens (up to 25 mm in diameter maximum). When there is full bearing on the sclera, further distinctions of the scleral lens group include mini-scleral and large-scleral lenses. This manuscript presents a review of the current applications of different ScCL (all types), their fitting methods, and their clinical outcomes including potential adverse events. Adverse events with these lenses are rare, but the clinician needs to be aware of them to avoid further damage in eyes that often are already compromised. The use of scleral lenses for non-pathological eyes is discussed in this paper.
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Boston ocular surface prosthesis (BOSP) is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP) failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens-Johnson syndrome (SJS). To report utilization of BOSP in a tertiary eye care center in India. We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA) before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. Thirty-two patients (43 eyes) received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P < 0.001). In patients with SJS, LogMAR VA was 0.84 ± 0.92 before and 0.56 ± 0.89 after lens wear. The P value was statistically significant (P < 0.001). VA improved by >2 lines in 7/20 eyes (35%) with SJS, with improvement in symptoms. BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS.
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Purpose: To evaluate the effect of the Boston Ocular Surface Prosthesis (Boston Foundation for Sight) on higher-order wavefront aberrations in eyes with keratoconus, eyes that have undergone penetrating keratoplasty, eyes that have undergone refractive surgery, and eyes with ocular surface diseases. Design: Prospective, clinical study. Methods: The study evaluated 56 eyes of 39 patients with irregular astigmatism who were treated with the Boston Ocular Surface Prosthesis when conventional treatments failed. Patients were sorted into 4 clinical groups based on the underlying cause of irregular astigmatism, including keratoconus (group 1), post-penetrating keratoplasty (group 2), post-refractive surgery (group 3), and ocular surface diseases (group 4). Another 6 eyes of 5 patients who were treated with rigid gas permeable lenses also were evaluated. Best-corrected visual acuity; topographic refractive indices, including spherical, cylindrical, spherical equivalent values; and higher-order and total wavefront aberration errors were noted at baseline and after fitting the lens. Results: In all groups, higher-order wavefront aberration error was noted to decrease significantly in eyes wearing the Boston Ocular Surface Prosthesis (P<.001, P=.001, P=.002, and P=.001, respectively). By post hoc analysis, significant differences in the level of higher-order aberrations were observed only between groups 1 and 4 (P=.012) and groups 1 and 2 (P=.033). In the overall group, mean correction rate of higher-order aberration error with the Boston Ocular Surface Prosthesis was 72.3%. However, in eyes with rigid gas permeable lenses, 2 eyes demonstrated increased higher-order aberration error, whereas the mean correction rate in other 4 eyes was only 42.5%. Conclusions: With its unique structure, the Boston Ocular Surface Prosthesis was found to be very effective in reducing higher-order wavefront aberrations in patients with irregular astigmatism resulting from a number of corneal and ocular surface conditions who had not responded satisfactorily to conventional methods of optical correction.
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To determine whether parameters of anterior corneal contour as identified by topographic analysis (steep and flat simulated keratometry, reference sphere) predict the base curve of Jupiter scleral lenses in patients with dry eye syndrome and keratoconus. We identified 33 eyes with dry eye syndrome and 21 eyes with keratoconus that were fit with Jupiter scleral lenses of standard design between June 2006 and July 2009. Steep and flat simulated keratometry powers and shape factor from axial topographic maps, reference sphere from elevation maps, and base curve of the scleral lens prescribed for each eye were recorded. Correlations between topographic indices and base curve were evaluated by using the Pearson correlation coefficient, and significances were completed by using generalized estimating equation models. In dry eye syndrome, the base curve of the final scleral lens prescribed correlated with the steep keratometric power (r = 0.70, P = 0.05, n = 33), the flat keratometric power (r = 0.71, P<0.001, n = 33), and the reference sphere (r = 0.73, P = 0.002, n = 33). In eyes with keratoconus, base curve also correlated with the steep keratometric power (r = 0.72, P<0.001, n = 19), the flat keratometric power (r = 0.70, P<0.001, n = 19), and the reference sphere (r = 0.68, P<0.001, n = 21). There were no correlations between base curve and shape factor. In eyes with normal and abnormal ocular contour, base curve of scleral lenses correlates with reference sphere and steep and flat keratometric powers, but the predictive relationship is weak (r ∼0.50). Diagnostic fitting may be the most efficient method of fitting scleral lenses at present.
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To describe the use of the Jupiter scleral contact lens (Medlens Innovations, Front Royal, VA or Essilor Contact Lens, Inc., Dallas, TX) in the management of ocular manifestations of chronic graft versus host disease (cGVHD). This study is a retrospective case series. Five consecutive patients with severe keratoconjunctivitis sicca (KCS) associated with cGVHD that could not be adequately managed with conventional therapy were evaluated for scleral contact lens wear between January and December 2007. All patients were evaluated with lenses from the standard 18.2 mm Jupiter B diagnostic fitting set. If lenses of standard design failed to provide adequate fit, custom lenses were designed. Three outcome measures were evaluated: the patient's ability to tolerate and successfully handle the lenses, improvement in symptoms of KCS, and improvement in visual acuity. All 5 patients (10 eyes) were successfully fit with Jupiter scleral lenses. Six eyes of 3 patients were successfully fit with lenses of standard design. Standard parameters were altered to achieve adequate fit in 4 eyes of 2 patients. All patients reported subjective improvements in comfort with Jupiter scleral lenses, and best-corrected vision improved in 7 of the 10 eyes fit within the first several months of contact lens wear. The remaining 3 eyes maintained the visual acuity measured before scleral lens wear (20/20 in 2 eyes, 20/40 in 1 eye). Duration of follow-up ranged from 4 to 14 months. Jupiter scleral lenses can relieve symptoms of KCS and may improve vision in patients with cGVHD.
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To describe the use of overnight wear scleral contact lenses (Scl CLs). The authors describe 7 patients using this modality of contact lens wear. Most of the lenses were made from highly gas-permeable materials, but a long-standing case is also reported when the lenses were made from PMMA, which is impermeable to gases. There is a range of therapeutic indications for the use of Scl CLs. The development of rigid gas-permeable (RGP) materials has widened this range. Seven case reports are presented which describe patients in whom severe ocular surface disease has been managed with overnight-wear Scl CLs. The indications were: corneal exposure, post-radiotherapy complications, Stevens Johnson disease, recurrent erosion and congenital or post-surgical lid defects. Scl CLs provide a therapeutic option for a range of complicated corneal and ocular surface conditions for which the treatment by other methods is either unsuitable or less effective. They have several advantages over silicone rubber and hydrogel lenses. The relative ease of handling for some patients allows removal for cleaning, their rigidity gives stability and a high degree of protection to the ocular surface, and the presence of a pre-corneal fluid reservoir optically neutralises an irregular corneal surface. Highly oxygen-permeable materials enable consideration of overnight wear in appropriate circumstances.
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Dry eye syndrome (DES) is believed to be one of the most common ocular problems in the United States (US), particularly among older women. However, there are few studies describing the magnitude of the problem in women and how this may vary with demographic characteristics. Cross-sectional prevalence survey. Study population: we surveyed 39,876 US women participating in the Women's Health Study about a history of diagnosed DES and dry eye symptoms. Main outcome measure: we defined DES as the presence of clinically diagnosed DES or severe symptoms (both dryness and irritation constantly or often). We calculated the age-specific prevalence of DES and adjusted the overall prevalence to the age distribution of women in the US population. We used logistic regression to examine associations between DES and other demographic factors. The prevalence of DES increased with age, from 5.7% among women < 50 years old to 9.8% among women aged > or = 75 years old. The age-adjusted prevalence of DES was 7.8%, or 3.23 million women aged > or = 50 in the US. Compared with Whites, Hispanic (odds ratio [OR] = 1.81, confidence interval [CI] = 1.18-2.80) and Asian (OR = 1.77, CI = 1.17-2.69) women were more likely to report severe symptoms, but not clinically diagnosed DES. There were no significant differences by income (P([trend]) =.78), but more educated women were less likely to have DES (P([trend]) =.03). Women from the South had the highest prevalence of DES, though the magnitude of geographic differences was modest. Dry eye syndrome leading to a clinical diagnosis or severe symptoms is prevalent, affecting over 3.2 million American women middle-aged and older. Although the condition is more prevalent among older women, it also affects many women in their 40s and 50s. Further research is needed to better understand DES and its impact on public health and quality of life.
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Keratoconjunctivitis sicca (KCS) occurs in 40%-60% of patients with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation. Although immunosuppressive therapy is the primary treatment of chronic GVHD, ocular symptoms require measures to improve ocular lubrication, decrease inflammation, and maintain mucosal integrity. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable scleral lens (SL) has been effective in mitigating symptoms and resurfacing corneal erosions in patients with KCS related to causes other than cGVHD. We report outcomes in 9 consecutive patients referred for SL fitting for cGVHD-related severe KCS that was refractory to standard treatments. All patients reported improvement of ocular symptoms and reduced the use of topical lubricants after SL fitting resulting from decreased evaporation. No serious adverse events or infections attributable to the SL occurred. The median Ocular Surface Disease Index improved from 81 (75-100) to 21 (6-52) within 2 weeks after SL fitting, and was 12 (2-53) at the time of last contact, 1-23 months (median, 8.0) after SL fitting. Disability related to KCS resolved in 7 patients after SL fitting. The use of SL appears to be safe and effective in patients with severe cGVHD-related KCS refractory to conventional therapies.
Article
Aim To determine the prevalence and identify associated risk factors for dry eye syndrome in a population in Sumatra, Indonesia. Methods A one stage cluster sampling procedure was conducted to randomly select 100 households in each of the five rural villages and one provincial town of the Riau province, Indonesia, from April to June 2001. Interviewers collected demographic, lifestyle, and medical data from 1058 participants aged 21 years or over. Symptoms of dry eye were assessed using a six item validated questionnaire. Presence of one or more of the six dry eye symptoms often or all the time was analysed. Presence of pterygium was documented. Results Prevalence of one or more of the six dry eye symptoms often or all the time adjusted for age was 27.5% (95% confidence interval (CI) 24.8 to 30.2). After adjusting for all significant variables, independent risk factors for dry eye were pterygium (p<0.001, multivariate odds ratio (OR) 1.8; 95% CI 1.4 to 2.5) and a history of current cigarette smoking (p=0.05, multivariate OR 1.5; 95% CI 1.0 to 2.2). Conclusions This population based study provides prevalence rates of dry eye symptoms in a tropical developing nation. From our findings, pterygium is a possible independent risk factor for dry eye symptoms.
Article
Purpose: The aim of this study was to describe the outcomes of 50% autologous serum (AS) eye drops after long-term use in a large cohort of patients with dry eyes. Methods: A retrospective cohort study was conducted on all patients treated with 50% AS eye drops at our institution between June 2008 and January 2013. Records were reviewed for clinical history, systemic risk factors, dry eye etiology, patients' symptoms, and adverse events. Ocular surface evaluation included Schirmer testing with topical anesthesia, fluorescein staining, and ocular surface disease index. Data were reviewed at initial visit, 1 month, and every 3 to 6 months during treatment with AS. Paired t tests were performed to compare the progression of signs and symptoms of dry eye disease. Results: A total of 123 eyes of 63 patients were evaluated with a mean follow-up of 12 months (range, 3-48 months). Corneal fluorescein staining (mean baseline, 1.77 ± 1.1) improved at the 3- to <6-month, 6- to <12-month, and final follow-up (mean: 1.2 ± 1.0, 1.3 ± 1.0, and 1.1 ± 1.1; P = 0.003, 0.017, and 0.0003, respectively). Schirmer scores (mean baseline, 6.6 ± 6.5 mm) improved at the 12- to 24-month follow-up (mean = 10.7 ± 11.4, P = 0.03), whereas ocular surface disease index scores (mean baseline, 54.1 ± 22.3) improved at the 3- to <6- and 6- to <12-month follow-up (mean: 49.5 ± 8.2 and 39.3 ± 21.4, P = 0.029 and 0.003, respectively). No complications were noted. Conclusions: Fifty percent AS eye drops seem to be a safe and effective long-term treatment for dry eye disease, especially in patients with severe disease who have exhausted all other conventional forms of treatment.
Article
Purpose: To investigate and validate methods for measuring the radius of anterior scleral curvature using anterior segment optical coherence tomography images. Methods: Twenty-four volunteers were enrolled in this study. Anterior segment optical coherence tomography images, centered on horizontal/vertical limbus, including adjacent anterior sclera, were obtained in addition to conventional images centered on the optical axis. Central horizontal, nasal, and temporal optical coherence tomography images were consolidated to a new image for subsequent analyses. The reference points of limbal surface and three scleral points were marked nasally and temporally. The radius of a best-fit circle to the six scleral points was derived (the BFC [best-fit circle] method) and the radii of two circles, the centers of which are on the optical axis and pass through the points of the scleral surface at 2 mm from the limbus nasally and temporally, were calculated (the axial method). To assess the reliability and accuracy of each method, intraobserver and interobserver agreements were analyzed and the radii of contact lenses with known curvatures were measured. Results: The mean (±SD) radius of a BFC was 13.12 (±0.80) mm. The mean (±SD) radius of nasal anterior scleral curvature (13.33 ± 1.12 mm) was significantly greater than that of temporal anterior scleral curvature (12.32 ± 0.77 mm) (paired samples t test, p < 0.001). The BFC and axial methods showed excellent intraobserver and interobserver agreements for measurements (intraclass correlation coefficient > 0.75, p < 0.001), whereas both methods showed a tendency to slightly underestimate the actual curvature of a rigid contact lens of known dimensions (-0.07 ± 0.13 mm [the BFC method] and -0.19 ± 0.07 mm [the axial method], Wilcoxon signed rank test, p = 0.173 and p = 0.028, respectively). Conclusions: Anterior segment optical coherence tomography is a valuable tool for measuring the radii of anterior scleral curvatures by image processing and mathematical calculation and can provide useful information in specific clinical situations such as designing scleral lenses.
Article
The aim of this study was to report and discuss the clinical experience with PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) practice at a tertiary eye care hospital. Retrospective data of patients who were prescribed PROSE during April 2011 to March 2012 in a tertiary eye care center in south India were analyzed. Data collected include patient demographics, indications of scleral lens fitting, previous correction modality, PROSE parameters, best-corrected visual acuity (BCVA) with spectacles, and BCVA with PROSE at initial assessment and few hours of wear. The BCVA before (with glasses) and after PROSE fitting was recorded in logMAR units. The age of the patients ranged between 13 and 68 years (male:female 60:25) with a mean age of 32.44±13.45 years. Mean BCVA improved by 0.3 logMAR units (3 lines) after fitting with PROSE. There was a statistically significant difference between pre- and post-PROSE BCVA (P=0.0001). Failure of rigid gas-permeable lens fitting or intolerance was the common indication for PROSE in corneas with irregular astigmatism (refractive conditions). The other reasons for which PROSE was prescribed were pain, photophobia, comfort, ghosting of images, and frequent loss of smaller lenses. Toric scleral haptic was indicated in 62 eyes. The diameter, vault, and haptic measurements of PROSE in ocular surface disorders were much less and flatter than that of refractive conditions. PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.
Article
To estimate dry eye prevalence in the Beaver Dam Offspring Study (BOSS), including a young adult population, and investigate associated risk factors and impact on health-related quality of life. Cohort study. The BOSS (2005-2008) is a study of aging in the adult offspring of the population-based Epidemiology of Hearing Loss Study cohort. Questionnaire data on health history, medication use, risk factors, and quality of life were available for 3275 participants. Dry eye was determined by self-report of frequency of symptoms and the intensity of those symptoms. Associations between dry eye and risk factors were analyzed using logistic regression. The prevalence of dry eye in the BOSS was 14.5%, 17.9% of women and 10.5% of men. In a multivariate model, statistically significant associations were found with female sex (Odds Ratio (OR), 1.68; 95% Confidence Interval (CI), 1.33-2.11), current contact lens use (OR, 2.01; 95%CI, 1.53-2.64), allergies (OR, 1.59; 95%CI 1.22-2.08), arthritis (OR, 1.44; 95%CI, 1.12-1.85), thyroid disease (OR, 1.43; 95%CI, 1.02-1.99), antihistamine use (OR, 1.54; 95%CI, 1.18-2.02), and steroid use (OR, 1.54; 95%CI, 1.16-2.06). Dry eye was also associated with lower scores on the Medical Outcomes Short Form-36 (β=-3.9, p<0.0001) as well as on the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) (β=-3.4, p<0.0001) when controlling for age, sex, and comorbid conditions. The prevalence of dry eye and its associated risk factors in the BOSS were similar to previous studies. In this study, DES was associated with lower quality of life on a health-related quality of life instrument and the vision-specific NEI-VFQ-25.
Article
Ocular graft-versus-host disease (GVHD) is a common complication that occurs after allogeneic transplantation. It can cause severe dry eyes that are described as having a burning, gritty, and painful sensation. Ocular GVHD can affect quality of life by causing pain and photophobia, limiting activities of daily living (e.g., reading, watching television), compromising safety while driving, and permanently damaging vision. Pre- and post-transplantation evaluations by an ophthalmologist are recommended. Routine assessments using the National Institutes of Health eye score should be administered to patients at each follow-up visit to their transplantation physician. Treatment options include lubricating eye drops, immunomodulator and steroid drops, and punctal occlusion. Relieving symptoms is difficult, and although multiple treatment options exist, many are ineffective. The Boston Foundation for Sight's scleral lens is an available option that promotes corneal healing and symptom relief. The current article discusses treatment options and supportive care measures for patients with ocular GVHD aimed at relieving symptoms and preventing complications.
Article
This is the first reported case of Acanthamoeba keratitis (AK) in a Boston scleral lens user. Consequently, the risk factors and treatment for AK need to be addressed in this unique case. We conducted a retrospective case study of a 45-year-old man using Boston scleral lens diagnosed with AK. Risk factors for infection and management of the condition were assessed. This 45-year old Boston scleral lens user's risk factors for developing AK included dry eye syndrome, autologous serum tear use, potential tap water exposure, and long-term systemic corticosteroid use. His infection was refractory to medical management and required deep anterior lamellar keratoplasty for curative treatment. Ophthalmologists should have a higher level of suspicion for AK in all scleral lens users and consider the use of deep anterior lamellar keratoplasty for refractory cases.
Article
Scleral contact lenses are used to treat symptoms of severe dry eyes. Procedures for fitting scleral lenses have been vague because of lack of standardized guidelines. This retrospective case series sought to establish average vault over central cornea in successful scleral lens wearers with dry eyes. Anterior segment optical coherence tomography was used to measure the distance between the posterior lens surface and cornea in 20 eyes of 12 consecutive patients successfully fit in the Vanderbilt Scleral Lens Clinic. Mean vault was 380 ± 110 μm. There was no correlation between vault and corneal curvature or vault and visual acuity. With a large SD in average vault, precision in central vault does not seem to be important in scleral contact lenses for successful fit for dry eyes.
Article
Objective: To describe the epidemiology of dry eye in the adult population of Melbourne, Australia. Design: A cross-sectional prevalence study. Participants: Participants were recruited by a household census from two of nine clusters of the Melbourne Visual Impairment Project, a population-based study of age-related eye disease in the 40 and older age group of Melbourne, Australia. Nine hundred and twenty-six (82.3% of eligible) people participated; 433 (46.8%) were male. They ranged in age from 40 to 97 years, with a mean of 59.2 years. Main outcome measures: Self-reported symptoms of dry eye were elicited by an interviewer-administered questionnaire. Four objective assessments of dry eye were made: Schirmer's test, tear film breakup time, rose bengal staining, and fluorescein corneal staining. A standardized clinical slit-lamp examination was performed on all participants. Dry eye for the individual signs or symptoms was defined as: rose bengal > 3, Schirmers < 8, tear film breakup time < 8, > 1/3 fluorescein staining, and severe symptoms (3 on a scale of 0 to 3). Results: Dry eye was diagnosed as follows: 10.8% by rose bengal, 16.3% by Schirmer's test, 8.6% by tear film breakup time, 1.5% by fluorescein staining, 7.4% with two or more signs, and 5.5% with any severe symptom not attributed to hay fever. Women were more likely to report severe symptoms of dry eye (odds ratio [OR] = 1.85; 95% confidence limits [CL] = 1.01, 3.41). Risk factors for two or more signs of dry eye include age (OR = 1.04; 95% CL = 1.01, 1.06), and self-report of arthritis (OR = 3.27; 95% CL = 1.74, 6.17). These results were not changed after excluding the 21 people (2.27%) who wore contact lenses. Conclusions: These are the first reported population-based data of dry eye in Australia. The prevalence of dry eye varies by sign and symptom.
Article
Article
Purpose: To determine the type and distribution of ocular conditions cared for in a clinic dedicated to scleral devices and to report the clinical outcomes afforded by this approach. Methods: Fifty-one charts of patients fitted unilaterally or bilaterally with a scleral device (Prosthetic Replacement of the Ocular Surface Ecosystem - PROSE) in a two year period were retrospectively reviewed. Patient demographics, ocular diagnoses, associated systemic conditions, best corrected visual acuity (BCVA) before and after fitting, Visual Function Questionnaire score (VFQ-25), and ocular surface disease index (OSDI) score were collected. Results: All 51 patients were successfully wearing the PROSE device for a period of anywhere from weeks to years. The most common reasons for fitting were to relieve symptoms of moderate to severe dry eye syndrome ("DES", n=25), management of refractive problems ("refractive", n=23) with keratoconus being the most common (n=14), and to manage other anomalies ("other", n=3). Best corrected visual acuity (logMAR) improved with the wearing of the PROSE device for both the DES (17 letters) and the refractive group (10 letters), but not the "other" group. No serious complications were recorded for any of the patients. Conclusions: The PROSE device is a useful option not only for the management of ocular surface disease and optical imperfections, but also for other ophthalmic conditions. Moderate to severe dry eye was the most common anomaly managed, followed by eyes with irregular corneal astigmatism. DES and refractive patients experienced improvement in visual acuity with wearing of the PROSE device.
Article
Purpose: To investigate the feasibility of correcting ocular higher order aberrations (HOAs) in keratoconus (KC) using wavefront-guided optics in a scleral lens prosthetic device (SLPD). Methods: Six advanced KC patients (11 eyes) were fitted with an SLPD with conventional spherical optics. A custom-made Shack-Hartmann wavefront sensor was used to measure aberrations through a dilated pupil wearing the SLPD. The position of SLPD, that is, horizontal and vertical decentration relative to the pupil and rotation were measured and incorporated into the design of the wavefront-guided optics for the customized SLPD. A submicron-precision lathe created the designed irregular profile on the front surface of the device. The residual aberrations of the same eyes wearing the SLPD with wavefront-guided optics were subsequently measured. Visual performance with natural mesopic pupil was compared between SLPDs having conventional spherical and wavefront-guided optics by measuring best-corrected high-contrast visual acuity and contrast sensitivity. Results: Root mean square of HOA in the 11 eyes wearing conventional SLPD with spherical optics was 1.17 ± 0.57 μm for a 6-mm pupil. Higher order aberrations were effectively corrected by the customized SLPD with wavefront-guided optics, and root mean square was reduced 3.1 times on average to 0.37 ± 0.19 μm for the same pupil. This correction resulted in significant improvement of 1.9 lines in mean visual acuity (p < 0.05). Contrast sensitivity was also significantly improved by factors of 2.4, 1.8, and 1.4 on average for 4, 8, and 12 cycles/degree, respectively (p < 0.05 for all frequencies). Although the residual aberration was comparable to that of normal eyes, the average visual acuity in logMAR with the customized SLPD was 0.21, substantially worse than normal acuity. Conclusions: The customized SLPD with wavefront-guided optics corrected the HOA of advanced KC patients to normal levels and improved their vision significantly.
Article
The aim of the DEWs Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. these guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.
Article
Aim: To report a rare case of microsporidial and polymicrobial keratitis in a patient with Sjogren's syndrome and ocular cicatricial pemphigoid. Method: This is a descriptive case report. A 66-year-old lady diagnosed with Sjogren's syndrome (SS) and ocular cicatricial pemphigoid (OCP) presented to us with microbial keratitis after using a Boston sclera contact lens for a painful epithelial defect. After 9 days of medical treatment, she underwent therapeutic penetrating keratoplasty. Results: 10% potassium hydroxide and calcofluor white wet mount revealed microsporidial spores. Gram positive cocci and Gram variable bacilli on Gram stain were identified as Staphylococcus epidermidis and Corynebacterium accolens in culture. Histopathological examination of the corneal tissue confirmed the presence of microsporidial spores. Conclusion: Microsporidal keratitis can occur in patients with severe ocular surface disease due to SS and OCP. Predisposing factors include dry eye, local and systemic immunosuppression and Boston scleral contact lens. Early surgical intervention may be needed to eradicate the infection.
Article
Purpose: Most ophthalmologists are unaware of the therapeutic applications of gas-permeable scleral contact lenses for the prevention and treatment of ocular complications in patients with facial nerve palsy and concomitant neuroparalysis. Methods: The case reports refer to 3 patients who developed unilateral lagophthalmos and corneal anesthesia after an acoustic neuroma or intracranial tumor resection. Two patients explicitly requested a tarsorrhaphy to be opened because they were incapacitated by the limited visual acuity and visual field. Tarsorrhaphy was not an acceptable aesthetic solution for the third patient. Fluid-ventilated scleral lenses were fitted because they protect the cornea by creating a precorneal fluid reservoir while optimizing visual acuity. Results: The follow-up periods were 3, 17, and 18 years. Two patients wear the contact lenses full time, but the wearing time is limited to 10 hours per day for the third patient. All patients were instructed not to wear their lenses while sleeping. Two eyes required a corneal transplant, but lens wear could be resumed 4 to 6 weeks after transplantation. The learning curve for the insertion and removal of this large-diameter lens is the main obstacle for a patient, especially when there is loss of corneal sensation. Conclusion: Scleral lens wear is a valid long-term alternative to standard treatment options such as tarsorrhaphy for patients with corneal exposure and corneal anesthesia as a consequence of postsurgery facial nerve paralysis. Scleral contact lenses provide these patients with effective protection of the ocular surface in an aesthetically acceptable way while optimizing visual function.
Article
Prosthetic replacement of the ocular surface ecosystem is a treatment developed by the Boston Foundation for Sight that uses a Food and Drug Administration-approved prosthetic device for the treatment of severe ocular surface disease to improve vision and discomfort in addition to supporting the ocular surface. Facial nerve paralysis has multiple causes including trauma, surgery, tumor, stroke, and congenital lagophthalmos. Subsequent lagophthalmos leading to exposure keratitis has been treated with copious lubrication, tarsorrhapy, eyelid weights, chemodenervation to yield protective ptosis, and palpebral spring insertion. Each of these treatments, however, has limitations and potential complications. The prosthetic replacement of the ocular surface ecosystem device provides a liquid bandage to protect the cornea from eyelid interaction and dessication in addition to improving vision. This report describes 4 patients with exposure keratitis who were successfully treated with prosthetic replacement of the ocular surface ecosystem devices at 2 clinical sites.
Article
Objective: To evaluate fitting feasibility and efficacy of mini scleral contact lenses in moderate to severe dry eye patients. Methods: Prospective interventional case series, this study included those patients with grades III and IV dry eye disease, whose symptoms could not be controlled by conventional treatments. Demographic data, UCVA, BSCVA were evaluated before fitting. Mini scleral lens fit was assessed by single experienced practitioner and best corrected vision with mini scleral lens was assessed. After dispensing mini scleral lens, BCVA with mini scleral lens, and possible contact lens related problems were assessed in each visit. Ocular comforts, frequency of artificial tear use, contact lens handling problems were asked in each follow up visit. For those who did not choose to wear lenses, the reason was asked. All data were analyzed using descriptive statistical tests. Results: Twenty eyes of 13 patients were fitted. Mini scleral lens was dispensed for 19 eyes in them assessment of fit was either ideal (n=9) or acceptable (n=10). Seven patients got their lenses; four patients (seven eyes) of them were satisfied with their lenses based on decrease in discomfort and dry eye symptoms, decrease artificial tear need frequency and improvement in visual acuity during mean follow up period of 18.25 months (range: 15-20). None of them was affected with any contact lens related complication. Conclusion: Mini scleral contact lenses can be considered helpful in management of moderate to severe dry eye.
Article
We report an interesting case of therapeutic scleral lens management of bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. Subsequent development of severe exposure keratitis with vascularisation and keratinisation of the inferior cornea was previously treated with intensive ocular lubrication, botulinum toxin injections to the upper eyelid levator muscle, temporary tarsorrhophies, bilateral amniotic membrane grafts, punctal plugs, lid taping, gold eyelid weights and soft bandage contact lenses. Corneal integrity was re-established but visual acuity remained significantly compromised by corneal vascularisation, scarring and keratin deposits. Visions on presentation to the contact lens department were R 1.90logMAR, L 1.86logMAR. Therapeutic, high Dk, non-fenestrated, saline filled, scleral lenses were fitted. Daily wear of these lenses have protected and hydrated the cornea, enabling corneal surface recovery whilst retaining visual and social function. The visual acuities 6 months post-scleral fitting with lenses in situ are R 0.90logMAR and L logMAR0.70.
Article
The aim of this study was to evaluate both the indications for and results of fitting the Jupiter Scleral Lens in patients with corneal abnormalities. This was a retrospective case review of 63 patients (107 eyes) fitted with scleral lenses between October 2009 and March 2011 at the UC Davis Eye Center. Sixty-three percent of 107 eyes were in patients with keratoconus. Other conditions included high postkeratoplasty astigmatism and corneal scarring. The improvement in best-corrected visual acuity compared with previous contact lens or glasses correction was a mean gain of 3.5 Snellen lines (SD=2.6). Seventy-eight percent of patients found the scleral lenses to be comfortable or comfortable. Twenty-five eyes discontinued the wear after at least 3 months. Jupiter Scleral lenses are a good alternative for patients with corneal abnormalities and for those who failed other types of lens rehabilitation. Seventy-seven percent of eyes fit with Jupiter Scleral Lenses were still wearing after a follow-up of 3 months.
Article
Objective To collect questionnaire data from patients in a large clinical population that would allow for an estimate of the prevalence of self-reported symptoms of dry eyes, Methods, A 13-point questionnaire (The Canada Dry Eye Epidemiology Study, CANDEES) was mailed to all optometric practices in Canada in October 1994, with the request that it be completed by 30 successive nonselected patients, Results, Four hundred fifty sets of questionnaires (total, 13,517) were analyzed (a 15.7% return rate) from patients aged from <10 years to >80 years; 55% were in the 21- to 50-year age group; 60.7% were female; and 24.3% were contact lens wearers, A total of 28.7% reported dry eye symptoms, of whom 24.2% reported concurrent dry mouth, 24.5% had worse symptoms in the morning, 30.3% reported concurrent lid problems, and 35.7% reported a history of allergies, Of the 3716 patients reporting symptoms, 62 (1.6%) were in the ''severe'' category and 290 (7.8%) were in the ''constant but moderate'' category, Contact lens wear, concurrent allergies, dry mouth, lid problems, or use of medications increased the chance of a patient reporting dry eye symptoms, Conclusions, The prevalence of patients reporting any level of symptoms of dry eyes was approximately 1 in 4; severe symptoms were reported by 1 in 225 patients.
Article
To study the indications and the challenges while fitting scleral contact lens (ScCL) filled with fluid prior to lens insertion in pediatric patients. We retrospectively reviewed charts of patients of 16 years or less who received ScCL (PROSE - Prosthetic Replacement of the Ocular Surface Ecosystem, Boston Foundation for Sight, Needham Heights, MA, USA) that were filled with fluid (Normal saline) before lens insertion during July 2006 to April 2010. The main goal of ScCL fitting was to improve vision in patients having keratoconus (KC) and improve the ocular microenvironment in ocular surface disease (OSD). Visual acuity before and after lens wear was noted. Fluid-filled ScCL were dispensed to 15 patients (20 eyes). The indications for ScCL fitting were KC (n = 3 eyes), Stevens Johnson syndrome (SJS, n = 13 eyes), radiation keratopathy (n = 1 eye), combined KC and SJS (n = 1 eye) and KC and vernal keratoconjunctivitis (VKC, n = 2 eyes). Mean age of the patients was 12.85 years. The average daily lens wear was 9 h. The vision improved by 2 lines or more in 85% and dropped by 2 lines or more in 45% eyes after 4 h of lens wear due to tear debris collection. None of the patients had any complications. Patients were self sufficient inserting and removing ScCL. Two patients had broken lenses during the follow-up. ScCL are useful for pediatric patients who have OSD, irregular astigmatism or the two coexisting; KC combined with VKC or SJS, helping to maintain the health of the ocular surface and improves vision in these patients.
Article
To evaluate the influence of peripheral ocular topography, as evaluated by optical coherence tomography (OCT), compared with traditional measures of corneal profile using keratometry and videokeratoscopy, on soft contact lens fit. Ocular surface topography was analyzed in 50 subjects aged 22.8 years (SD ±5.0) using videokeratoscopy (central keratometry, corneal height, and shape factor) and OCT to give both full sagittal cross-sections of the cornea and cross-sections of the corneoscleral junctions. Corneoscleral junction angle, corneal diameter, corneal sagittal height, and scleral radius were analyzed from the images. Horizontal visible iris diameter and vertical palpebral aperture were analyzed from digital slit lamp images. Lens fit was graded after 30 minutes wear of a -2.50 D commercially available standard hydrogel (etafilcon A, modulus 0.30 MPa) and silicone hydrogel (galyfilcon A, 0.43 MPa) design of similar geometries (8.30-mm base curve, 14.0-mm diameter). The mean horizontal corneal diameter was 13.39 mm (SD ±0.44). In many cases, there was a tangential transition at the corneoscleral junction. The corneoscleral shape profile analyzed from cross-sectional OCT images contributed significantly (P < 0.001) to the prediction of soft contact lens fit compared with keratometry and videokeratoscopy, accounting for up to 24% of the variance in lens movement. The fit of the stiffer material silicone hydrogel lens was better able to be predicted and was more varied than the hydrogel contact lens. The extra peripheral corneoscleral data gained from OCT characterization of ocular surface architecture provide valuable insight into soft contact lens fit dynamics.
Article
To describe the therapeutic benefits of scleral lenses in the management of severe ocular surface disease attributable to toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). Retrospective study. Clinical records of 39 patients (67 eyes) fitted with scleral lenses for refractory ocular surface disease attributable to SJS or TEN were reviewed. To assess vision-specific quality of life, each patient completed the Ocular Surface Disease Index (OSDI) questionnaire and the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Slit-lamp examination was performed at regular intervals to detect side effects. Main outcome measures were best-corrected visual acuity (VA) and OSDI and NEI VFQ-25 composite score before and 6 months after scleral lens fitting. The mean age was 35.8 +/- 13.9 years. Scleral lens fitting failed in 3 patients. The mean follow-up was 33.3 +/- 17.6 months. Among fitted patients, VA in the better eye (36 patients, 36 eyes) progressed from 0.73 to 0.50 logarithm of the minimum angle of resolution (P = .0001) 6 months after scleral lens placement. The mean OSDI improved from 76.9 +/- 22.8 to 37.1 +/- 26.7 (P = .0001). Thirty-two NEI VFQ-25 composite scores were available. The mean NEI VFQ-25 composite score improved from 25.1 +/- 16.8 to 67.4 +/- 22.1 (P = .0001). No serious adverse events attributable to the scleral lenses occurred. Scleral lens use appears to be efficient and safe for visual rehabilitation of refractory ocular surface disease attributable to TEN and SJS.