November 2022
Column
The Dry Eye Ally
At the recent SUMMIT meeting in Soronto (IT) hosted by Daddi Fadel and Melissa Barnett, a couple of really interesting pearls surfaced in presentations and discussions from the floor. With representatives from 22 countries, this really was the ideal podium to discuss several interesting topics. Ken Pullum (from the UK) discussed how to deal with keratoconus patients who develop cataracts. How do you determine the power of the IOL (difficult) and what does that mean for the (scleral) lens that the patient might be wearing? Or Jan Bergmanson from Houston (US), who described the exact six (!) pathways of intraocular pressure (IOP) release by the various structures of the eye. One thing mentioned was the potential of adaptation by some of those ocular structures to the potential IOP increase caused by scleral lens wear. In other words, even if there is such an increase due to the scleral lens, the eye may adapt to it. But maybe what had the most impact was the discussion on dry eye. The delegates at the meeting pretty much unanimously agreed that we need to talk to other practitioners, both in and outside of the eyecare field, to explain what scleral lenses can do for dry eye patients, as they can potentially change lives. In some of the larger scleral lens practices in the world, scleral lens management for dry eye can be as much as 50% of the indication range, as Muriel Schornack from the Mayo clinic in Rochester (US) indicated. Scleral lenses can be an ally in dry eye management. We can be an ally for dry eye patients.
Myopia
Vision-Related Quality of Life
What seems to be increasing clear from a clinical standpoint is that there are several options for myopia management in children, and our industry should not be 'myopic' about this by focusing on contact lens options alone. Special optical glasses and atropine could be great options for children as well. The most important consideration may be: what is the compliance of the child with the modality chosen? The success of the treatment mostly relies on that: how well the intervention method is accepted and used consistently. Various interventions have been shown to slow axial elongation in children. In a study by Michael Lipson et al, these interventions were evaluated to assess efficacy in slowing axial elongation, correction of vision, and the related quality of vision, risk of adverse events, overall safety, but also the overall impact on vision-related quality of life (VR-QoL). The development and use of validated survey instruments to assess the patient-reported outcomes is discussed in the paper. The review demonstrates that there are numerous factors that may impact VR-QoL that need to be evaluated in the decision-making process by eyecare providers on when, how and whether to prescribe myopia management for children with myopia. Photo by Ben Wicks on Unsplash.
Orthokeratology's Efficacy and Safety
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In another paper, by the same lead author, in Eye & Contact Lens - the role of ortho-k specifically to slow axial elongation and progressing degree of myopia is explored. Children undergoing ortho-k have shown significant slowing of axial elongation and myopia progression. This review presents data on the efficacy, benefits, and risks of the use of ortho-k to slow axial elongation in myopic children. It discusses how ortho-k fits into an overall strategy of myopia management in practice compared with alternative prescribed interventions to slow myopia progression. Other factors discussed are patient candidacy, impact on vision-related quality of life, and use of ortho-k in combination with pharmaceutical agents. With precise fitting, careful follow-up, and patient compliance with recommended lens cleaning and disinfection, ortho-k may be considered a safe and effective method to slow axial elongation in children, according to the author - but these terms may be as important as the end result itself.
Rigid Corneal Lenses for Myopia Management
The aim of a study from China was to explore the clinical effect of a rigid corneal lens (RCL) in improving vision and controlling myopia progression of children with unilateral high myopia. In this retrospective analysis case series study, the clinical data for 23 subjects under 6 years old with unilateral high myopia were analyzed. The spherical equivalent refractive error of the myopic eye was between -5.0D and -12.0D. Fourteen subjects were successfully fitted with the RCL, and nine subjects (control group) used a spectacle lens. In the RCL group, the change in axial length (AXL) of the high-myopic eye was from 25.62±1.31mm to 25.69±1.31mm after 12 months. The change in spherical equivalent (SE) was from -8.73±2.54D to -8.48±2.77D in the same period. In the spectacle group, the AXL changed from 24.76±0.56mm to 24.94±0.71mm, and the SE changed from -6.16±2.86D to -9.45±2.06D. In conclusion: wearing RCLs is a convenient and effective method for children with unilateral high myopia to improve the best-corrected vision and control myopia progression. Image: Irving Martínez Navé
Scleral Lens Indication Range
Limbal-Rigid Contact Lens Wear
for Ocular Surface Disorders
A relatively unknown lens type is that of limbal-rigid contact lenses (RCLs). Compared to scleral lenses, the diameter of limbal-RCLs is generally smaller, typically ranging from 13.0mm to 14.0mm, and they are designed so that the peripheral edge bears on the limbus. A novel limbal-RCL has a design with multistep curves on the peripheral edge for easy tear exchange during blinking that removes debris and prevents lens clouding or fogging, thus allowing patients to enjoy a longer daily duration of lens wear, according to the authors. In severe ocular surface disease (OSD), limbal-RCLs after surgery are a noninvasive therapeutic approach that can neutralize corneal irregularities, decrease dry eye symptoms, prevent the progression or recurrence of symblepharon, and improve the patient's visual acuity and overall quality of life, according to the authors. Surgeries such as amniotic membrane transplantation and cultivated oral mucosal epithelial transplantation, as well as limbal-RCL wear, are all valuable and effective treatment strategies that can be considered for the management of patients afflicted with severe OSD, the authors state.
Dry Eye and Irregular Cornea Management with Sclerals After Refractive Surgery
Refractive surgery continues to be a successful alternative for patients, but sometimes problems arise post-surgery. What can be the role of scleral lenses in the management of not just the irregular cornea but also dry eye? Investigators from France looked into this. They included 19 patients (35 eyes) with irregular corneas after refractive surgery. Patients were fitted with scleral lenses after the failure of conventional contact lenses. Scleral lens fitting statistically significantly increased the best-corrected visual acuity from 0.33±0.25 to 0.08±0.13 LogMAR. Ocular aberrations were statistically significantly reduced by the scleral lenses. And there was a statistically significant decrease in Ocular Surface Disease Index scores from 66.2±22.8 to 42.4±18.9. Fitting scleral lenses improves patients' optical and ocular surface problems; the investigators conclude: scleral lenses restore vision and the quality of life. Fitting with scleral lenses is an alternative to further surgery on these fragile eyes and is sometimes the only viable treatment option for the patient.
SCOPE survey
SCOPE it out again! After going through data collected for a small pilot project on this topic, the SCOPE study group is now broadening our investigation of the use of diagnostic lenses/preformed fitting sets, image-based lenses, and impression-based lenses when fitting patients with keratoconus in practices across the globe, and they’d love to include your input. This 10-minute survey will give the entire scleral lens community a better idea of how these lens fitting paradigms are utilized in clinical practice. If you complete the survey, you will have the opportunity to enter your name in a drawing for a $150 Amazon gift card.
Webinar
Scleral Lens Research and Clinical Implications
In the gpli.info webinar archive is an excellent presentation by Gloria Chiu on scleral lens research and clinical implications, which was originally presented on Tuesday, September 20th, 2022. Gloria is an Associate Professor of Clinical Ophthalmology at the USC Roski Eye Institute, Department of Ophthalmology at the University of Southern California Keck School of Medicine (US). She explores the research behind scleral lenses. What to look for in research? How to review and judge a published paper? What is masked? What is the impact factor of a journal? This webinar helps you to dissect the scientific literature, focused specifically on scleral lens research.
Global Specialty Lens Symposium 2023
I-site is an educational newsletter that is distributed on a monthly basis and provides an update on rigid gas permeable-related topics (scientific research, case reports and other publications worldwide). I-site is objective and non-political. Disclosure: I-site's editor Eef van der Worp, optometrist PhD FAAO FBCLA FIACLE FSLS, receives educational grants from a number of industry partners but is not related to any specific company.