Study: Scleral lenses for keratoconus after hydrops

Study of 14 patients, the majority of whom were able to avoid corneal grafts as they got satisfactory vision with mini scleral lenses.

The Outcome of Scleral Lens Fitting for Keratoconus With Resolved Corneal Hydrops. Kreps et al, Cornea. 2019 July.

Abstract

PURPOSE:

To investigate the success and failure of scleral lens fitting in patients with keratoconus with resolved hydrops.

METHODS:

Retrospective case series of patients with keratoconus who attended the Ophthalmology Department at Antwerp University Hospital, Belgium, and developed acute hydrops between January 1, 2015, and June 30, 2018. The exclusion criteria included amblyopia, mental retardation, and insufficient follow-up.

RESULTS:

Of the 25 patients with keratoconus with acute hydrops, 14 patients (16 eyes) were included in this study. Median age was 31 years (range 19-52 years). Before hydrops, the median maximum keratometry value of affected eyes was 81.3 D (range 66.3-108.3 D). Acute hydrops was managed medically in 5 eyes (31.3%), by observation in 5 eyes (31.3%), by application of bandage contact lens in 1 eye (6.3%), and compression corneal sutures in 5 eyes (31.3%). Contact lens fitting after hydrops was not necessary for 2 patients (2 eyes; 12.5%) because of excellent vision in the fellow eye. Of the remaining patients, 11 (68.8%) were successfully fitted with mini-scleral lenses, with a median visual acuity of 0.7 (0.5-0.9; decimal Snellen). Three patients (3 eyes; 18.8%) proceeded to graft surgery because of limited visual acuity with scleral lenses (n = 2) or persistent edema (n = 1).

CONCLUSIONS:

Scleral lenses are effective for providing satisfactory visual acuity after corneal hydrops in keratoconus. A scleral lens trial is advised before listing patients for graft surgery.

EyePrintPRO therapeutic scleral lens

This is the first paper I remember seeing about EyePrintPRO in an ophthalmology journal! So excited. I know some great things have been presented at meetings, but it's nice to see something on a PubMed search now.

EyePrintPRO is an amazing technology, where lenses can be created from a physical mold of the eye surface. I've been fortunate enough to be wearing EPP lenses for about four years now myself, and I feel awfully spoiled. Not everyone, of course, needs the highest technology lenses, and there's a high price on technologies like these, but their existence is a godsend for those who need them, particularly those who have special fitting difficulties that just can't be solved with more conventionally designed lenses.

This abstract is only on ten patients, but there are many people being fitted now all over the country. Mine were fitted by Roya Habibi in Seattle. I enjoyed reading the list of indications that the ten patients in the study had for the lenses:

• LSCD (limbal stem cell deficiency)

• PRK (the laser refractive surgery without the flap) decentred ablation

• pellucid marginal degeneration

• Stevens-Johnson syndrome

• keratoconus

• dry eye

• neurotrophic keratitis, exposure keratitis from facial nerve paralysis

• RK (radial keratotomy, the thing they used to do before PRK and LASIK)

I feel like I'm in good company with the PRK and RK patients. I have central islands (which everyone always assumes came from an old broadband excimer laser... only, they didn't... it was a VISX Star S3, which was pretty hot stuff back in 2001) and off-the-charts spherical aberration plus a fair amount of pain. I get good vision and comfortable days with the right lenses, but the only lenses I've ever been able to successfully wear long term have been PROSE and EyePrintPro.

The inventor of EPP lenses, Dr Christine Sindt from U of Iowa, is one of those wonderful eye doctors who combine being an extraordinary scientific leader in their field with heart-warming kindness towards patients. We've had the good fortune to have her input now and then in our FB scleral lens group. 

Can J Ophthalmol. 2018 Feb;53(1):66-70. doi: 10.1016/j.jcjo.2017.07.026. Epub 2017 Sep 28.

EyePrintPRO therapeutic scleral contact lens: indications and outcomes.

Nguyen MTB1, Thakrar V2, Chan CC3.

Author information

Abstract

OBJECTIVE:

To describe indications and outcomes of patients fitted with the EyePrintPRO therapeutic scleral lens.

METHODS:

A database search of patients fitted with the EyePrintPRO from 2014 to 2016. Fourteen eyes of 10 patients were reviewed retrospectively. Patient demographics, medical and ocular history, indications for fitting, duration of wear, symptoms, and best-corrected visual acuity (BCVA) were analyzed.

RESULTS:

Mean age at lens fitting was 49 years (range, 21-67 years). The average duration of wear was 12 months (range, 7-17 months). Indications for fitting included limbal stem cell deficiency, post-photorefractive keratectomy (PRK) decentred ablation, pellucid marginal degeneration, Stevens-Johnson syndrome, keratoconus, dry eye, neurotrophic keratitis, exposure keratitis from facial nerve paralysis, and post-radial keratotomy (RK) symptoms. Mean BCVA was 20/36 (range, 20/20-20/200). After the fitting, mean BCVA was 20/21 (range 20/10-20/60, p = 0.001). Nine patients reported resolution of their blurry vision, and all reported improvement of dry eye, eye redness, and pain symptoms. Six of 7 previous lens wearers reported significantly greater comfort with EyePrintPRO wear and the ability to wear the lens throughout the day; only 2 experienced fogging and needed to clean the lens after 4-6 hours of wear.

CONCLUSIONS:

A variety of indications for the EyePrintPRO scleral lens exist, and patients experience resolution of major symptoms. The ophthalmologist should be aware that therapeutic scleral lenses, including the EyePrintPRO, exist for patients for whom there is no surgical intervention or who want to delay or obviate the need for surgery.

Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

p.s. Just after I posted this, I saw the March 2018 newsletter from Scleral Lens Monthly - on the exact same topic! Great reading. 

High success rates for scleral lenses in graft-v-host-disease patients

These numbers are unsurprising to anyone who knows people with severe chronic GvHD (when they develop severe dry eye, among other things, following a bone marrow transplant for example), but nonetheless impressive:

• 97% of patients had improvement in quality of life

• 92% of patients continued to use sclerals (mean follow-up time was more than 1.5 years)

• Corneal damage, vision and quality of life were all assessed 2 months after starting and all improved

Bone Marrow Transplant. 2017 Jun;52(6):878-882. doi: 10.1038/bmt.2017.9. Epub 2017 Feb 20.Scleral lenses for severe chronic GvHD-related keratoconjunctivitis sicca: a retrospective study by the SFGM-TC.Magro L1,2, Gauthier J1,2, Richet M3, Robin M4, Nguyen S5, Suarez F6, Dalle JH7, Fagot T8, Huynh A9, Rubio MT10, Oumadely R11, Vigouroux S8, Milpied N8, Delcampe A12, Yakoub-Agha I1,2,13.Author informationAbstractChronic GvHD-related keratoconjunctivitis sicca (cGvHD-related KCS) can significantly alter the quality of life of patients after allogeneic hematopoietic stem cell transplantation. The aim of this work was to assess the efficacy and tolerability of scleral lenses to treat severe cGvHD-related KCS. In this retrospective, multicenter study, we included 60 consecutive patients diagnosed with cGvHD-related KCS and fitted with scleral lenses. Patients were evaluated at baseline and at 2 months with the following tests: the Ocular Surface Disease Index (OSDI) to assess quality of life, the Oxford score to grade corneal damage and the logarithm of minimal angle of resolution (Log MAR) scale to determine visual acuity. We observed improvement in quality of life in 58 patients (97%). All parameters improved at 2 months. We observed significant differences at 2 months compared with baseline for the mean OSDI (86 versus 30, respectively, P<0.001), the mean Oxford score (3.2 versus 1.3, respectively, P<0.001) as well as visual acuity (Log MAR of 0.33 versus 0.10, respectively, P<0.001). Treatment with scleral lenses was discontinued in only 5 patients (8%) with a median follow-up of 20.5 months (range: 2-125 months). Scleral lenses were very efficient and well tolerated in patients with severe cGvHD-related KCS.