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Keratoconus Contact Lenses Fitting
To calculate and validate a new web-based algorithm for the selection of the posterior optical region radius (BOZR) of a spherical gas permeable (GP) lens in keratoconus eyes.
Contact Lenses For Keratoconus
We performed a retrospective calculation (n = 35; multiple regression analysis) and subsequent receiver validation (a fresh sample of 50 keratoconus eyes) of a new algorithm to determine the BOZR of GP lenses with a KAKC spherical design ( Konoptica) in keratoconus. The BOZR was calculated using the new algorithm, manufacturer’s instructions, and APEX software and compared with the BOZR that was last described. The number of diagnostic lenses, lenses needed, and visits to achieve an optimal fit were recorded and compared with those obtained for the control group [50 healthy eyes with spherical GP (BIAS design; Konoptica)].
= 0.825, p < 0.001). The BOZR of the first diagnostic lens using the new algorithm showed less difference from the final described BOZR (-0.01 ± 0.12 mm, p = 0.65; 58% difference ≤ 0.05 mm) than the guidelines manufacturer (+0.12 ± 0.22 mm, p < 0.001; 26% difference ≤ 0.05 mm) and APEX (-0.14 ± 0.16 mm, p = 0.001; 34% difference ≤ 0 .05 mm). Numbers close to diagnostic lens (1.6 ± 0.8, 1.3 ± 0.5; p = 0.02), required lens (1.4 ± 0.6, 1.1 ± 0.3; p < 0.001) and visits (3.4 ± 0.7, 3.2 ± 0.48; ) were required to match keratoconus and healthy eyes, respectively.
This new algorithm (free access at www.calculens.com) improves the spherical fit of KAKC GP in keratoconus and can reduce clinician time and patient chair time to achieve an acceptable final fit in keratoconus. This algorithm minimizes the differences between a GP keratoconus (KAKC design) and standard GP lenses (BIAS design) suitable for healthy eyes. Bay Eye Care are experts in fitting and managing all types of contact lenses. Bay Eye Care is the ideal practice if you need special contact lenses for clearer vision due to a severe corneal condition such as keratoconus, clear marginal degeneration, high prescription or corneal transplant. We also help contact lens wearers who prefer not to wear glasses all day.
As Bay Eye Care is a specialist contact lens practice, we are able to access contact lens support from the Department of Health for patients who are medically unable to wear glasses to see effectively. This partial grant contributes to part of the costs associated with the fitting and supply of Bay Eye Care contact lenses if you meet certain criteria.
Multifocal Lenses For Presbyopia In Eyes With Previous Corneal Surgery
The type of contact lens that is best for you depends on a number of factors. Your Bay Eye Care optometrist will consider these aspects when recommending a method:
These lenses are worn all day, usually come in a variety of daily and monthly replacements, and can correct a wide variety of prescriptions.
OCT showing a solid, rigid lens fitting over a patient with a central corneal scar. You can see that the contact lenses do not touch the eye in this place.
These lenses are worn throughout the day and are usually intended for patients with tall or complex prescriptions, such as keratoconus patients. With proper care, they last longer than soft lenses, usually one to two years. Rigid lenses have two different subtypes:
Current Perspectives In The Management Of Keratoconus With Contact Lenses
These lenses are only used when you sleep. They reshape the front surface of the eye so you can see clearly all day long when the lenses are removed. They can correct a range of prescriptions and last up to a year in most cases. Orthotic lenses are especially helpful in slowing the progression of myopia in children and reducing dependence on reading glasses as we age. For more information on this method, visit the orthopedics page.
Most of Bay Eye Care’s rigid and Ortho-K lenses are manufactured locally in Christchurch by Contact Lens Corporation of New Zealand and are designed using Eyespace’s advanced lens design software.
Before wearing contact lenses, people often have a number of questions about themselves and what being a contact lens wearer entails. More information about contact lenses can be found here: Bay Eye Care Contact Lenses General Information Sheet.
Our ophthalmologist, Mr. Alex Petty, is a contact lens specialist with years of experience fitting contact lenses and educating patients on how to use their lenses safely and successfully. Since all contact lenses are medical devices, it is essential that there are no shortcuts in the fitting process or an increased risk of problems. All contact lens wearers should be checked every 12 months to make sure their eyes are staying healthy. Depending on your eye doctor’s recommendation, some patients are seen more often than this.
Managing Keratoconus Rigid Contact Lens Options
Graphic representation of the shape of the eye of a patient with astigmatism. Information like this is important when designing custom contact lenses at Bay Eye Care.
At Bay Eye Care, we use a range of advanced equipment to help us fit contact lenses to your eyes. This technology involves measuring the shape of your eye, scanning the contact lens layers of the cornea, taking digital images of the fit of the contact lens to your eye, and creating custom lens designs using this data using software from EyeSpace simulation.
For an indication of the cost of a professional contact lens fitting at our clinic, visit the Bay Eye Care Fee Structure (CXL) page Crosslinked Corneal Ligation (CXL) has had widespread clinical acceptance since April 2016, when the US Food and Drug Administration approved the Avedro KXL System. , which slows or stops progressive keratoconus. Today, CXL is the standard of care for progressive keratoconus, and many health insurances cover this procedure.
However, most keratoconus patients still need special contact lenses to get the best visual results after CXL. Recently, there has been talk that CXL may facilitate the prescription of contact lenses for keratoconus.
Management Of Keratoconus: Current Scenario
Although the primary goal of CXL is disease stabilization, the procedure can also reduce corneal curvature and surface irregularities. According to data submitted to the Food and Drug Administration, the maximum keratometry value in the CXL treatment group decreased by 1.6D from baseline to 1 year.
With a flat cornea after the procedure, it seems intuitive that contact lens professionals will have an easier time prescribing contact lenses. However, is there peer-reviewed literature to support this claim? Here, we take a closer look.
CXL temporarily reduces corneal sensitivity for about six months, after which sensitivity levels return to their preoperative levels.
In a confocal microscopy study, we could see that the subbasal nerve plexus was not visible in 90% of patients 1 month after surgery, but corneal innervation almost recovered to levels 6 months before surgery.
Scleral Lens On Keratoconus With Dry Eyes And Piguecula Case Study By Optometria Y Superacion
These results confirm the results of a previous study investigating CXL acceleration, which also found that subbasal nerve fiber density was reduced after CXL.
From this literature, we can conclude that reduced corneal sensation after CXL is likely to improve contact lens tolerance during the first 6 months after the procedure.
Researchers evaluated 20 eyes of 14 keratoconus patients who underwent CXL and reported improvement in favorable gas-solid ratios (GPRs) and personalized patient comfort.
Among their findings, they note that all patients reported tolerable fits, with 20% experiencing an increase in near-perfect fit and a 65% improvement in personal comfort with more than eight hours of lens wear comfortable contacts.
Slit Lamp Assessment Of A Diagnostic Scleral Lens Applied To An Eye…
Although subjectivity is present with what constitutes an improved RGP fit relationship, the marked improvement in subjective patient comfort could be due to relative corneal hypoesthesia after CXL.
A review article on CXL recently reported an unpublished study of contact lens tolerance in a small prospective randomized clinical trial of 10 people (eight keratoconus, two ulcers) who underwent CXL.
Before CXL, 62.5% of keratoconus patients (5/8) reported partial or good lens tolerance, while 90% of all patients (9/10) reported satisfactory lens tolerance lenses at the conclusion of the study.
The authors state that despite the limited sample size and single-lens design, these results may show early evidence of improved contact lens tolerance in post-CXL patients.
New Web Based Algorithm To Improve Rigid Gas Permeable Contact Lens Fitting In Keratoconus
Looking closely at the two studies above, several things become apparent. The practitioner’s skill level can contribute to improved fitting relationships, patient comfort, and lens tolerance. It is not clear in either study whether participants were prescribed contact lenses by the same physician before and after CXL. If patients were prescribed original lenses by a less experienced doctor who handed over the frenulum to a more skilled doctor after CXL, it would not be surprising to find tighter ties and lens satisfaction. In the latter study, there was no control of lens design prior to CXL. These patients would have worn an ill-fitting RGP lens preoperatively and were prescribed a well-fitting hybrid lens postoperatively and experienced improvement simply due to changes in lens type or fit ratio, not CXL . In general, the sample size in both studies is too small to achieve a reliable and accurate result.
The left map was taken six months after the operation, the middle map was taken before the operation and the right map is the difference or subtracted map showing 2.5D of Kmax flattening . Note the upper slope and lower flatness over the cone, which represents the normalization of the cornea
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