Progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses

PurposeTo investigate the rate of progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses (pancorneal RGP-CL) compared to non-pancorneal RGP-CL. We also evaluated alterations in anterior chamber parameters with the progression of keratoconus and investigated the location of the cone in eyes with keratoconus.MethodsThe current study was a retrospective study including patients with clinically evident keratoconus from the outpatient clinic from the Department of Ophthalmology of the Erasmus Medical Center, Rotterdam, the Netherlands. Medical history and contact lens characteristics were documented. All participants underwent ophthalmic examination including corneal topography. Corneal topography was repeated at one of the consecutive visits of the patient. Patients were divided into two groups: those wearing pancorneal RGP-CL and those wearing other contact lens types. As a measure of progression of keratoconus differences in corneal topography parameters between both groups were compared.ResultsA total of 82 patients were included of which 42 had follow-up (mean 17.8 months) data. We found a significant difference in progression between eyes fitted with and without pancorneal RGP-CL (K-flat: p = 0.09, K-steep: p = 0.02, K-mean: p = 0.02, and K-minimum: p = 0.04). Compared with eyes fitted without pancorneal RGP-CL no significant difference in K-values was found for eyes fitted with pancorneal RGP-CL during follow-up. Furthermore, a significant decrease in anterior chamber volume (p < 0.001) and corneal volume (p = 0.008) was found during follow-up. In 86.6% the location of the cone was located infero-temporal.ConclusionsPancorneal RGP-CL have a better effect on stabilizing progression of keratoconus than non-pancorneal RGP-CL. The finding of an infero-temporal location of the cone in keratoconic corneas may improve results of contact lens fitting and surgical management.     

Clinical evaluation of different types of contact lenses in keratoconus management

PurposeTo compare the clinical and topographical findings of the keratoconus patients according to the prescribed contact lens type and to investigate the effects of corneal collagen cross-linking (CXL) and cone location on lens selection.MethodsThe records of 301 eyes of 195 keratoconus patients who were prescribed contact lenses were analyzed retrospectively. The eyes were grouped according to the lens type: Soft toric contact lens (STCL), rigid gas-permeable contact lens (RGPCL), hybrid contact lens (HCL) and mini-scleral contact lens (MSCL). The history of having CXL, ophthalmological examination findings, and the topographical findings were compared between the groups. Brown-Forsythe, Chi-square, and post-hoc tests were used to compare the groups. Mann-Whitney U test was used for subgroup analysis. Comparison of the lens-corrected visual acuity (LCVA) and spectacle-corrected visual acuity (SCVA) levels was made with Wilcoxon signed-ranks test.ResultsThere was no significant difference between the groups regarding topographical cone location, CXL history, spherical refraction, and LCVA. The difference between spectacle-corrected visual acuity and LCVA was higher in RGPCL and MSCL groups than STCL group (p=0.01). Keratometry of RGPCL and MSCL groups were higher than STCL and HCL groups (p=0.01, p<0.001). In RGPCL group, eyes with central cones had a higher increase in visual acuity with contact lenses compared to eyes with paracentral cones (p=0.043). STCL and MSCL were mostly prescribed in mild and severe keratoconic eyes, respectively. In RGPCL group, the increase in visual acuity with contact lens was higher in eyes treated with CXL (p= <0.01).ConclusionsWhile STCL and HCL were mostly prescribed in mild keratoconus, RGPCL and MSCL were selected for moderate or advanced disease. If appropriately chosen, all types of contact lenses could result in a good visual acuity level. CXL history did not affect the prescribed lens type. Having central cone location and CXL history in RGPCL group improved visual acuity more efficiently.     

New web-based algorithm to improve rigid gas permeable contact lens fitting in keratoconus

Purpose

To calculate and validate a new web-based algorithm for selecting the back optic zone radius (BOZR) of spherical gas permeable (GP) lens in keratoconus eyes.

Semi-automatic measurement of rigid gas-permeable contact lens movement in keratoconus patients using blinking images

Purpose

To introduce a method for estimation of the rigid gas-permeable contact lens (RGP) movement.

Corneal topography for pancorneal toric edge rigid gas-permeable contact lens fitting in patients with keratoconus,and differences in age and gender

PurposeTo determine whether pancorneal rigid gas-permeable toric edge contact lenses (pancorneal RGP-CL) fitting could be improved by using non-central corneal shape predictors, and to compare these parameters with respect to age and gender in patients with keratoconus.MethodsThe current study was a retrospective study including patients with clinically evident keratoconus (on videokeratography) from three medical centres located in the Netherlands. Medical history, visual acuity, refraction, and contact lens characteristics were documented. All participants underwent ophthalmic examination including measurement of K-values (steepest, flattest, mean, as a non-central parameter the minimum radius [K-minimum], and all combined) using corneal topography. Fitting of contact lenses was based on the fluorescence pattern as seen during slitlamp examination.ResultsA total of 378 eyes of 218 patients with keratoconus were included. Of these, 257 (68%) were fitted with a pancorneal RGP-CL. The central K-values, K-steep and K-flat, performed well in predicting the base curve radius, though, for pancorneal RGP-CL the non-central K-minimum added most (35.5%) to the total explained variance in base curve radius. Regarding age and gender, women tended to have larger K-values than men. No differences in K-values were found with respect to age.DiscussionWe found that including the K-minimum as a non-central parameter may improve prediction of the best base curve radius for pancorneal RGP-CL and may reduce the number of trial contact lenses. In line with other studies, suggestive evidence was found for a difference in pattern of progression of keratoconus with gender, but not with age.     

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

Purpose

To analyse the visual quality achieved by fitting corneo-scleral contact lenses (CScL) in an uncommon case of bilateral keratoconus, high hyperopia and astigmatism.

Bitoric rigid gas permeable contact lenses in the optical management of penetrating keratoplasty

PurposeThe purpose of this study was to evaluate the complexity and effectiveness of fitting bitoric rigid gas permeable contact lenses (RGPCLs), compared to spherical RGPCLS, when used in the correction of high amounts of post-penetrating keratoplasty astigmatism.MethodsRecords of post-penetrating keratoplasty (PKP) patients being managed with bitoric RGPCLs were compared to controls (post-PKP patients managed with spherical RGPCLs). Factors that were analyzed included the number of diagnostic RGPCLs used to assess the initial fit, the number of RGPCLs ordered to finalize the fit and the number of total doctor visits to finalize the fit.ResultsFourteen eyes of 14 patients satisfied the study criteria. The average amount of total astigmatism in this study group was 10.0 D ± 5.0 compared to the control group which was 3.3 D ± 2.6. The number of diagnostic RGPCLs used for the study group was 1.2 ± 0.4 compared to 1.0 ± 0.0 for the control group. The mean number of contact lenses ordered to complete the fitting for the study group was 1.9 ± 0.7 compared to the control which was 2.1 ± 0.8. The study group presented for an average of 6.3 ± 1.6 visits whereas the control group presented for 4.9 ± 1.1 visits. Contact lens corrected acuity for the study group was 0.101 ± 0.11 (20/25) compared to the control group 0.08 ± 0.12 (20/24).ConclusionsThe complexity of fitting bitoric RGPCLs was found to be similar to fitting spherical RGPCLs on post-PKP eyes and the visual outcomes were not different.     

An approach for simulating the fitting of rigid gas-permeable contact lenses using 3D printing technology

ObjectiveTo introduce a new approach to simulatethe fitting process of rigid gas-permeable (RGP) contact lenses using 3D printing technology.MethodsA hemispherical or parabolic 3D model was created using 3D Builder or Tinkercad software. The horizontal and vertical diameters and the hemispherical or ellipsoid height were adjusted to simulate different morphologies of the corneal anterior surface. After exporting the file in stereo lithography (STL) format, a solid model was printed using a 3D printer and was used to simulate RGP contact lens fitting.ResultsLimited by the precision of the entry-level 3D printer which was used in this study, the print-outs of the corneal models were crude, but the models were tested for their ability to simulate common corneal morphologies with no corneal astigmatism and different axial corneal astigmatism. Compared with some built-in simulation programs for corneal topography, the solid models generated by 3D printing could well simulate the positioning of the lens under the influence of gravity and the eyelid, as well as lens eccentricity or the bubbles under lenses caused by an improper wearing method.Conclusion3D printing technology can be well applied in the simulation of RGP contact lens fitting, which may become a new teaching method in optometry.     

Computational analysis of retinal image quality with different contact lens designs in keratoconus

PurposeTo determine 1) the relative differences in optical quality of keratoconic eyes fitted with four routinely used CL designs and 2) the Zernike coefficients in the residual wavefront aberration map that may be responsible for differences in the optical quality of keratoconic eyes fitted with these CLs.MethodsWavefront aberrations over a 3-mm pupil diameter were measured without and with Kerasoft IC®, Rose K2®, conventional spherical Rigid Gas Permeable (RGP), and Scleral CLs in 15 mild to moderate keratoconic eyes (20 – 28 years) and under unaided viewing in 10 age-similar non-contact lens wearing controls. The resultant through-focus curves constructed for the logarithm of Neural Sharpness (logNS) Image Quality (IQ) metric were quantified in terms of peak value, best focus, and depth of focus. Sensitivity analyses determined the impact of the residual Zernike coefficients of keratoconic eyes fitted with CLs on the IQ of controls at emmetropic refraction.ResultsThe peak IQ and depth of focus were similar with Rose K2®, conventional RGP, and Scleral CLs (p > 0.05, for all) but significantly better than Kerasoft IC® CLs (p < 0.01 for all). Best focus was similar across all four CLs (p > 0.2 for all). However, the IQ parameters of all the lenses remained significantly poorer than the controls (p < 0.01, for all). The IQ of the controls dropped to keratoconic levels with induced residual lower-order Zernike terms and 3rd-order coma across all lenses in the sensitivity analysis (p < 0.001).ConclusionsIQ of keratoconic eyes remain suboptimal with routinely dispensed CL designs, largely due to residual lower-order aberrations and coma, all relative to the controls. The performance drop appears greater for the Kerasoft IC® CL relative to the other CL designs. These results may provide the optical basis for psychophysical spatial visual performance reported earlier across these four CL designs for keratoconus.     

Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients

PurposeThis study was conducted to evaluate the effects of long-term use of rigid gas-permeable (RGP) contact lenses on corneal endothelium in keratoconus (KC) patients using non-contact specular microscopy. In addition, the correlation between wearing duration of RGP lenses (years & hours /d) and endothelial morphometric changes in KC patients was performed. This may provide more useful data for clinical application of RGP contact lens.Study designThis study was a prospective, observational, comparative, hospital based, nonrandomized, cross-sectional, and quantitative study.Subjects and methodsThe study included 40 eyes of non-wearer contact lens KC patients (group 1) and 38 KC eyes with a long history of Rose K2 RGP contact lens wearing (group 2). The corneal endothelial morphology such as endothelial cell density (ECD); coefficient of variation of cell area (CV); percentage of hexagonal cells (HEX); and central corneal thickness (CCT) were evaluated in all patients using SP3000P Specular Microscope.ResultsThe study included 40 eyes of non-wearer contact lens KC patients (20 mild KC eyes and 20 moderate KC eyes) and 38 KC eyes with a long history of RGP contact lens wearing (18 mild KC eyes and 20 moderate KC eyes). The mean duration of RGP lenses wearing was 5.67 ± 3.481 years & 12.11 ± 2.698 h/d in mild KC eyes and 7.15 ± 5.294 years &13.65 ± 2.889 h/d in moderate KC eyes. Wearing duration in hours in mild KC eyes showed a significant moderate negative correlation with ECD (r = ?0.529, p = 0.024) and a moderate positive correlation with CV (r = 0.565, p = 0.015). In addition, wearing duration in years in moderate KC eyes showed a significant moderate negative correlation with ECD (r = ?0.465, p = 0.039) and moderate positive correlation with CV (r = 0.627, p = 0.003). However, wearing duration in hours in moderate KC eyes showed a significant moderate negative correlation with HEX only (r = ?0.490, p = 0.028). This study reported significant corneal thinning in contact lens wearer KC eyes in contrast to non-wearer KC eyes.ConclusionThis study documented a significant correlation between a long-term use of Rose K2 RGP using the three-point touch and corneal endothelial morphometric changes in KC patients. In addition, the current study confirmed a significant corneal thinning in RGP contact lens wearer compared to non-contact lens wearer KC patients. Further studies are recommended to evaluate the association between different RGP lens materials with different oxygen permeability transmissibility; different lens design types; different fitting methods; the duration of contact lens wear and the endothelial morphometric changes in KC patients.     

The accuracy of Goldmann applanation tonometry over silicone hydrogel contact lenses in patients with glaucoma

PurposeTo investigate the accuracy of measuring intraocular pressure over a silicone hydrogel contact lens using Goldmann applanation tonometry in eyes with glaucoma.MethodsThis was a prospective, randomized study and enrolled 28 patients (28 right eyes) with primary open angle glaucoma. Intraocular pressure was taken with and without a silicone hydrogel contact lens (−0.50 D), in situ (using Goldmann applanation tonometry), in a randomized order of measurements. Statistical analysis was performed using paired t-test and Bland–Altman plot.ResultsThe mean difference (± standard deviation) found between intraocular pressure measurement without (mean 16.7 ± 3.2 mmHg) and with (mean 17.3 ± 3.0 mmHg) contact lens was found to be −0.57 ± 2.3 mmHg (95% confidence interval, −1.5 to 0.3). No significant statistical difference was found between the two groups with paired t-test (p = 0.19). The Bland Altman plot showed some evidence of increasing variability of differences between two measures of intraocular pressure, with increasing intraocular pressure. The 95% limits of agreement of the Bland Altman plot were unacceptably large (−5 mmHg to 3.9 mmHg).ConclusionAgreement between Goldmann applanation tonometry with and without contact lenses seems to be poor in patients with glaucoma, especially for high intraocular pressure.     

Changes in visual quality with soft contact lenses after the instillation of hyaluronic acid eye drops

PurposeTo evaluate the changes in visual function and anterior surface aberrations during soft contact lens (SCL) wear after the instillation of hyaluronic acid (HA) eye drops with different viscosity.MethodsA prospective, randomized, and participant-masked study was performed. Twenty healthy participants (25.4 ± 2.6 years) were evaluated. Hydrogel (Ocufilcon D) and silicone-hydrogel (Somofilcon A) SCL were randomly assigned to both eyes of the same participant. Visual function in terms of high- and low-contrast corrected distance visual acuity (CDVA) and anterior contact lens surface aberrations (RMS HOA) were measured before and after the instillation, at different times, of different eye drops: saline (control) and 0.1%, 0.2%, and 0.3% HA.ResultsCompared with the saline solution, during hydrogel SCL wear, there was an improvement (P < 0.05) in high-contrast CDVA after 3 and 10 min with 0.1% HA, and after 5 and 20 min with 0.2% HA. During silicone-hydrogel SCL wear, there was a deterioration (P < 0.05) in high-contrast CDVA after 1 and 30 min with 0.3% HA. Additionally, during silicone-hydrogel SCL wear, there was also a deterioration (P < 0.05) in low-contrast CDVA after 5 and 20 min with 0.3% HA. In terms of RMS HOA, there were no clinically relevant changes with both SCL.ConclusionsThe instillation of HA eye drops could have a different effect on visual quality depending on their concentration of HA, the contact lens material, its surface ionicity, or other physicochemical properties that should be studied in future studies.     

Impact of corneal collagen cross-linking on vision-related quality of life measured with the keratoconus outcomes research questionnaire (KORQ) in patients with keratoconus

PurposeTo assess the impact of corneal collagen cross-linking on self-reported vision-related quality of life (VR-QoL) in keratoconus patients by means of the Keratoconus Outcomes Research Questionnaire (KORQ), a new disease-specific patient reported outcomes measures (PROMs) tool.MethodsPatients with progressive keratoconus undergoing corneal collagen cross-linking were consecutively enrolled. Patients completed the KORQ before and after the treatment, at 1, 3 and 6 months. Data were collected regarding the visual acuity and the topographic, aberrometric and pachymetric parameters of both eyes. Patients were also asked to quantify their eye rubbing behavior on a Visual Analogue Scale (VAS) from 0 to 10, before and 6 months after treatment.The KORQ scores were associated with the visual acuity, topographic, aberrometric and pachymetric data by means of the Spearman correlation coefficient.ResultsThe Activity Limitation (AL) subscale score was higher after surgery. Preoperatively, negative correlations were observed between the KORQ AL score and Best Corrected Visual Acuity (logMAR), maximum keratometry, flattest keratometry, steepest keratometry, symmetry index front and higher order aberrations (HOA) of the treatment eye. Postoperatively, we observed a shift toward the fellow eye, with stronger correlation of the KORQ scores with the fellow eye parameters. The Symptoms subscale score correlated with the aberrometric parameters of both eyes at various time points. Statistically significant correlations were observed between the change in KORQ scores and the change in aberrometric parameters. A statistically significant reduction in the eye rubbing behavior was detected (p < 0,0001).ConclusionsThese results suggest that the corneal cross-linking treatment is effective both in improving the subjective perception of the disease by the patient and in stabilizing the objective indicators of disease progression. Keratometric, aberrometric and visual acuity values showed a significant impact on self-reported VR-QoL. Corneal cross-linking, by halting the worsening of these parameters, may bear a beneficial effect on VR-QoL.