Contact Lens Fitting in Patients with Keratoconus – A Retrospective Assessment of 200 Patients

2021 ◽  
Author(s):  
Kathrin Richter ◽  
Theresia Jullien ◽  
Ulrike Klühspies ◽  
Achim Langenbucher ◽  
Berthold Seitz ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contact Lens ◽  
Contact Lenses ◽  
Visual Outcome ◽  
Drop Out ◽  
Back Surface ◽  
Corneal Transplant ◽  
Wide Range ◽  
Fitting In ◽  
Contact Lens Fitting

Abstract Background and Purpose Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes. Patients and Methods This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting. Results The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages “1” to “2” (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages “2 – 3” to “4”. Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting. Conclusions The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.

scholarly journals Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty

2013 ◽  
Vol 2 (2) ◽  
pp. 69-72
Author(s):  
Rafael J Pérez-Cambrodí ◽  
Pedro Ruiz-Fortes
Keyword(s):  
Visual Acuity ◽  
Contact Lens ◽  
Contact Lenses ◽  
Anterior Segment ◽  
Successful Outcome ◽  
Imaging Evaluation ◽  
Visual Rehabilitation ◽  
Distance Visual Acuity ◽  
Fitting In ◽  
Contact Lens Fitting

ABSTRACT Purpose To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP). Materials and methods A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting. Results Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and .5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 μm to a postfitting value of 1.57 μm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations. Conclusion The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment. How to cite this article Pérez-Cambrodí RJ, Ruiz-Fortes P, Llorens DPP. Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty. Int J Kerat Ect Cor Dis 2013;2(2):69-72.

scholarly journals Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus

2017 ◽  
Vol 6 (2) ◽  
pp. 97-100
Author(s):  
Roberto Soto-Negro
Keyword(s):  
Contact Lens ◽  
Potential Benefit ◽  
Contact Lenses ◽  
Spherical Model ◽  
Future Studies ◽  
Rigid Contact ◽  
The Stability ◽  
Fitting In ◽  
Contact Lens Fitting

ABSTRACT We report the case of a 35-year-old woman diagnosed with keratoconus since she was 18 years old and wearer of corneal rigid contact lenses (CLs). We refitted the case with the fully scleral CL ICD16.5 (Paragon Vision Sciences) for obtaining not only a successful visual restoration, but also a comfortable wear. We initiated the fitting with the spherical model of the CL, but it failed due to instability of the lens. We confirmed the presence of a clear asymmetry in the anterior scleral geometry in both eyes by using the profilometer eye surface profiler (ESP, Eaglet Eye), with a difference between nasal and temporal sagittal heights of 470 and 170 μm in right and left eyes respectively. Although this profile suggested the need for the fitting of a CL with significant peripheral toricity, we followed the manufacturer's guidelines and performed a trial with a CL of moderate peripheral toricity (125 μm of difference between steep and flat meridian). The stability of the CL failed again and finally a CL with a peripheral toricity close to that measured with the profilometer was fitted. With this lens, good visual performance, lens stability, and comfort was obtained and maintained during a 1-year follow-up. This case suggests that fully scleral CLs fitting might be optimized with the use of corneo-scleral profilometers, minimizing potentially the number of trials. This potential benefit should be investigated further in future studies. How to cite this article Piñero DP, Soto-Negro R. Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus. Int J Kerat Ect Cor Dis 2017;6(2):97-100.

scholarly journals A case report of visual outcome in keratoconus with retinitis pigmentosa

2018 ◽  
Author(s):  
Chiun-Ho Hou ◽  
Yun-Wen Chen ◽  
Ken-Kuo Lin ◽  
Jiahn-Shing Lee ◽  
Lai-Chu See ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Retinitis Pigmentosa ◽  
Contact Lens ◽  
Contact Lenses ◽  
Life Quality ◽  
Visual Outcome ◽  
Visual Aids ◽  
Blurred Vision ◽  
Visual Rehabilitation

Abstract Background: It is uncommon to see retinitis pigmentosa in keratoconus patients. The main difficulty of visual rehabilitation for this is restricted visual field. We presented the treatment and gene screen of visual system homeobox 1 (VSX 1) gene in this case. Case presentation: A 24-year-old man with retinitis pigmentosa presented with progressively blurred vision. Slit lamp examination revealed Vogt’s striae over both eyes, and corneal topography indicated bilateral keratoconus. We had tested 5 exons of VSX 1 gene from him and the did not find mutation on direct sequence. To improve visual acuity, we prescribed keratoconus rigid gas permeable (RGP) contact lens for him with good efficacy. However, lens dislocation occurred occasionally. He could not find dislocated lens easily due to visual field restriction, so he asked for more stable visual aids. Therefore, we instead prescribed scleral lens (SL), which were more stable on the ocular surface and led to more stable vision. Visual acuity was also gained with SL, but the tolerance time for SL was shorter compared to that of keratoconus RGP contact lens. To compare the efficacy of these two lenses, we surveyed life quality using the National Eye Institute Visual Functioning Questionnaire – 25 in three situations: baseline, with keratoconus RGP contact lens, and with SL. Conclusion: The patient used the two lens types according to his needs, and benefited from vision rehabilitation with both keratoconus RGP contact lens and SL. Keywords: keratoconus; retinitis pigmentosa; rigid gas permeable contact lenses; scleral lenses.

scholarly journals Preliminary Clinical Exploration of Scleral Lens Performance on Normal Eyes

2018 ◽  
Vol 2 (2) ◽  
pp. e14-e21
Author(s):  
Melissa Barnett ◽  
Jonathon Ross ◽  
Blythe Durbin-Johnson
Keyword(s):  
Visual Acuity ◽  
Contact Lens ◽  
Healthy Subjects ◽  
Contact Lenses ◽  
Front Surface ◽  
Contact Lens Wear ◽  
Factors Associated ◽  
Rigid Contact ◽  
Lens Wear ◽  
Spectacle Correction

Abstract Objectives: The purpose of this study was to evaluate the performance (i.e. vision, comfort and fit) of spherical and front-surface toric scleral lenses in subjects with regular, healthy corneas. Methods: Scleral lenses were fitin the eyes (n = 16) of healthy subjects (n = 9) with regular corneas, absent of pathology, and studied using an observational, multi-visit design. Lens fit was objectively evaluatedby an experienced practitioner.Following 1 month of successful lens wear, participants completedsubjective satisfaction surveys regarding the scleral lens wearing experience. Results:  According to participant surveys, scleral lenses were subjectively preferred over soft toric or gas permeable contact lenses in 88% of eyes, including in all eyes fit with a front-surface toric scleral lens (n = 3). Seventy-five percent (75%) of eyes achieved visual acuity of 0.1 logMAR or better, while all eyes with prior spectacle wear achieved visual acuity with a scleral lens within 1 Snellen line of spectacle correction. Seventy-five percent (75%) of eyes achieved good subjective comfort with a scleral lens. No participants reported poor subjective vision and/or comfort. Conclusions:  Our findings suggest that subjects preferred the performance of a scleral lens (spherical or front-surface toric) compared to a soft toric or gas permeable contact lens. Moreover, scleral lenses may provide a viable, alternative contact lens modality option for patients considering discontinuation of traditional soft toric and/or rigid contact lens wear; so long as the factors associated with hypoxia remain minimized. Key Words:  scleral lens; scleral contact lens; front-surface toric scleral lens; lens performance; normal eyes; healthy eyes

scholarly journals Influence of scleral lenses on visual acuity and aberrations in patients with irregular cornea

The Eye ◽  
2019 ◽  
Vol 126 (2019-2) ◽  
pp. 32-39
Author(s):  
Olga Tikhonova ◽  
Nikolai Pashtaev ◽  
Nadezhda Pozdeyeva ◽  
Alexander Myagkov ◽  
Svetlana Bodrova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Laser Surgery ◽  
Contact Lenses ◽  
Lens Space ◽  
Astigmatism Correction ◽  
Intrastromal Corneal Ring ◽  
Stable Vision ◽  
Ring Segment ◽  
Ophthalmologic Examination ◽  
Fitting In

Purpose: To analyze changes of functional parame¬ters and aberrations before fitting and after using rigid gas-permeable scleral lenses (RGPSCL) in patients with irregular cornea. Material and methods. 21 patients (29 eyes) with irregular astigmatism of various etiology were enrolled in this study. The patients could not achieve good visual aсuity in glasses, standard soft or rigid corneal contact lenses. Complex ophthalmologic examination was per¬formed: autorefractometry, visometry, biomicroscopy, computer corneal topography, aberrometry on “OPD-Scan II” (“Nidek”, Japan) before fitting scleral lenses and during the period of their wearing. Results and discussion. The results demonstrat¬ed significant visual acuity improvement after RGP¬SCL fitting in all observed patients. UCVA amounted to 0.1±0.18, BCVA in glasses amounted to 0.4±0.26, BCVA in RGPSCL amounted to 0.7±0.1. An increase of best-corrected visual acuity in RGPSCL was statistically significant in patients after keratoplasty, after intra-stromal corneal ring segments (ICRS) implantation, af¬ter refractive laser surgery (RLS) and in cases of mixed astigmatism. We have found that the correction of ker¬atoconus with the use of RGPSCL resulted in a decrease of the root mean square value (RMS), measured in the 3 mm and 5 mm zones by 2.5 times and 4 times, re¬spectively. In patients wearing RGPSCL after kerato¬plasty, statistically significant decrease in RMS was observed in the 3 mm zone (by 3.85 times) and in the 5 mm zone (by 2.99 times). In patients wearing RGPSCL after implantation of intrastromal corneal ring segment (ICRS), RMS in the 3 mm zone decreased by 1.5 times. In patients wearing RGPSCL after refractive laser surgery (RLS) RMS was 2.5 times lower in the 3 mm zone and 2.8 times lower in the 5 mm zone. In case of mixed astigmatism correction with RGPSCL, RMS increased by 1.6 times in the 3 mm zone and practically did not change in the 5 mm zone. Conclusion. The results obtained demonstrated significant visual acuity improvement in all observed patients. The sub-lens-space filled with tear forms a unified “cornea-tear-scleral contact lens” optic system that corrects unevenness of cornea, decreases amount of high-order aberrations (HOA) and provides a clear stable vision.

Contact Lens Fitting in Aphakia

2006 ◽  
pp. 125-129
Author(s):  
Adamo Lui Netto ◽  
Jeffrey J. Walline
Keyword(s):  
Contact Lens ◽  
Fitting In ◽  
Contact Lens Fitting
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