Contact lenses for Keratokonus
Contact lenses are the primary form of visual correction for patients with keratoconus
Laura Downie and Richard Lindsay
Contact lenses are the primary form of visual correction for patients with keratoconus. Contemporary advances in contact lens designs and materials have significantly expanded the available fitting options for patients with corneal ectasia. Furthermore, imaging technology, such as corneal topography and anterior segment optical coherence tomography, can be applied to both gain insight into corneal microstructural changes and to guide contact lens fitting. A review paper from Downie and Lindsay
provides a comprehensive summarize of the range of contact lens modalities, including soft lenses, hybrid designs, rigid lenses, piggyback configurations, corneo-scleral, mini-scleral and scleral lenses currently available for the optical management of keratoconus.
The Scientific Bureau of World Society of Paediatric Ophthalmology and Strabismus recommends treatment options for myopia control
Seo Wei Leo
In a review paper, Seo Wei Leo from the Scientific Bureau of World Society of Paediatric Ophthalmology and Strabismus concluded that controlling the onset of myopia is now possible through increasing time outdoors whereas slowing the progression of myopia can be successfully achieved with interventions like atropine and orthokeratology.
Hand washing essential for safe and effective contact lens wear
Desmond Fonn and Lyndon Jones
Lack of or inadequate hand washing is a risk factor in the development of contact lens related microbial keratitis and corneal inflammatory events. There is compelling evidence that proper hand washing with soap can save lives, which it is now of outmost importance during the covid pandemic. Contact lens wearers are also guilty of poor hand washing behavior but there is scant evidence that education of hand washing procedures of lens wearers alters patient non-compliance. Adequate patient education with regards to hand hashing is critical for safe and effective contact lens wear
The International Myopia Institute has synthesed the research evidence to date on the most important and relevant aspects related to myopia, including recommended guidelines for myopia control
International Myopia Institute
With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions should be appropriately and ethically applied. The International Myopia Institute, with help from more than 85 multidisciplinary experts in the field, recently published seven critical reviews that syntheses the research evidence to date on the most important and relevant aspects related to myopia. These reports form the basis for recommended guidelines for eye care practitioners.
Contact lenses for Children
The Safety of Soft Contact Lenses in Children
Mark A Bullimore
There is increasing interest in fitting children with soft contact lenses. A review collated data from a range of studies to estimate the incidence of complications, specifically corneal infiltrative events and microbial keratitis, in patients under the age of 18 years.
Nine prospective studies representing 1800 patient years of wear in 7- to 19-year-olds included safety outcomes. In three large prospective studies representing between 159 and 723 patient years of soft contact lens wear in patients 8 to 14 years, the incidence of corneal infiltrative events is up to 136 per 10,000 years. Data from a large retrospective study show similar rates of corneal infiltrative events: 97 per 10,000 years in 8- to 12-year-olds and 335 per 10,000 years in 13- to 17-year-olds. None of the prospective studies report any cases of microbial keratitis. One retrospective study found no cases of microbial keratitis occurred in 8- to 12-year-olds and an incidence of 15 per 10,000 patient years in 13- to 17-year-olds -no higher than the incidence of microbial keratitis in adults wearing soft contact lenses on an overnight basis. This review concluded that the incidence of corneal infiltrative events in children is no higher than in adults, and in the youngest age range of 8 to 11 years, it may be markedly lower.
Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update
Wolffsohn et al.
A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. Over 1300 eye care practitioners from the 5 different continents responded to the questionnaire. Concern was highest in Asia and lowest in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active, the North American practitioners being the least active. Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses. Most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression, but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost and inadequate information. While practitioner concern about myopia and the reported level of activity have increased in recent years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes.
Soft contact lens wearers' compliance during the COVID-19 pandemic
Vianya-Estopa et al.
An online survey distributed in the UK and Ireland explored contact lens wearers' compliance behaviors, attitudes and concerns during the COVID-19 pandemic. Two hundred and forty-seven responses were received (34.3 ± 11.7 years old, 79% female). Seventy nine percent of participants reported that they were self-isolating or rigorously following social distance advice. Fifty-six percent of participants reported using their lenses less during the pandemic. Eighty-seven percent of respondents reported following the recommended 20-second rule most times/every time and 96% used soap and water during handwashing. Eleven percent of respondents admitted not following recommendations regarding disposal of lenses and 18% would not consider ceasing lens wear if unwell (with flu/cold) during the pandemic. In summary, respondents reported wearing their contact lenses less than usual. In summary, although good compliance with handwashing was observed during the COVID-19 pandemic, soft reusable lens wearers showed a statistically significant lower compliance with lens wear and care compared to daily disposable lens wearers.
Contact Lens Care
Subjective Comfort and Physiology with Modern Contact Lens Care Products
Berntsen et al
A study compared subjective comfort and ocular physiology with three multipurpose solutions (MPSs) to that of a peroxide-based system with three different soft contact lens materials in 236 habitual soft contact lens wearers. Subjects were randomly assigned to one of three lens types, including one hydrogel and two silicone hydrogel contact lenses. A new lens of the assigned type was worn for 10 to 14 days each while using one of four MPSs. After using each care solution, biomicroscopy was performed and subjective comfort and comfortable wear time (CWT) were assessed and compared to that of the peroxide solution. Comfort score across all lens types with each MPS was not significantly different than with the peroxide solution. There were no differences in CWT between each MPS and the peroxide solution for any lens. Six MPS/material combinations had no clinically meaningful change in corneal staining versus peroxide. Staining was < grade 1 for all combinations. In conclusion, comparable levels of comfort were found between the latest generation of MPSs compared to peroxide disinfection indicating that the current lens care systems investigated in this study are generally appropriate for use with the contact lenses tested.
α Ortho-K Results of a Three-Year Clinical Trial on Treatment of Myopia in Children
CHANG Yong, XIE Pei-ying, WANG De-chen, CHI Hui, XHOU Jian-lan
Beijing Internet Eyecare Optometry & Ophthalmology Clinic
To evaluate the effect and safety of long-term wearing high precision ORTHO-K contact lens for myopic
children and adolescents.
Retrospective case series.
150 myopic children and adolescents.
We examined 150 patients (300 eyes) who wore ORTHO-K lens for 3 years in Beijing Internet Eyecare Optometry & Ophthalmology Clinic. Following examinations had been performed for baseline and all annual follow-up visits: slit lamp exam, uncorrected visual acuity (UCVA), and tear secretion, eye axial length, corneal thickness, corneal endothelial cell density, percentage of hexagon and corneal curvature values. We also selected 66 eyes switching to ORTHO-K from other brands for evaluation of comfort, clarity and cleanliness.
The COVID-19 pandemic: Important considerations for contact lens practitioners
Lyndon Jones et al
A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions.
Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?
Manbir Nagra et al
The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients. Approaches to teleoptometry in contact lens practice primarily includes smartphone based ocular imaging and assessment of visual acuity. However, the absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during a pandemic. Advances in the field, such as ocular self-imaging, could help move this field forwards.
Antimicrobial properties of new rigid gas-permeable contact lens multipurpose solution formulated with polylysine as disinfecting agent
Osamu Mori and Megumi Toyohara
A study presented at a recent conference of the British Contact Lens Association compared the antimicrobial properties of a new rigid gas-permeable (RGP) contact lens multipurpose solution (MPS) formulated with Polylysine as disinfecting agent against other commercially available MPS formulated with other disinfecting agents. Four commercially available RGP-MPS were compared according to ISO14729 stand-alone disinfection test: MPS-A (polylysine), MPS-B (PHMB + chlorhexidine), MPS-C (PHMB), MPS-D (Oxychlorite + hydrogen peroxide) and MPS-E (Polyquad). Antimicrobial properties were assessed with/without artificial tear as organic load for time (5–360 min) and temperature-dependence (10–32 ºC). MPS-A, MPS-B and MPS-E showed sufficient efficacy under all test conditions. MPS-C showed insufficient efficacy against fungi and decreased efficacy at low temperature and with organic load. MPS-D barely showed efficacy against all microorganisms tested. The new RGP-MPS formulated with Polylysine represents a safe and effective care solution for use with rigid gas-permeable contact lenses.
Mark A Bullimore and Leah A. Johnson
A recent publication in the Contact Lens & Anterior Eye provided an interesting review of the current status of the use of overnight orthokeratology contact lenses. Overnight orthokeratology lenses are currently approved in countries all over the world for the temporary reduction in myopia, and recently, one lens design has received regulatory approval for myopia control in Europe. The modern orthokeratology lens has a substantial history from its origins of attempting to flatten the corneal curvature with a spherical rigid contact lens to sophisticated gas permeable lenses, designed to reshape the cornea. Currently, these lenses are predominantly prescribed for children to slow myopia progression and limit axial elongation of the eye. The article reviews the peer-reviewed literature on the efficacy of orthokeratology for myopia control, sustainability after treatment is discontinued, and the safety concerns of overnight contact lens wear.
Short-term and long-term changes in corneal power are not correlated with axial elongation of the eye induced by orthokeratology in children
Jacinto Santodomingo-Rubido et al
In this study, it was assessed the relationship between short-term and long-term changes in power at different corneal locations relative to the change in central corneal power and the 2-year change in axial elongation relative to baseline in white European children wearing orthokeratology contact lenses (Ortho-K).
The result showed the reduction in central corneal power and relative increase in paracentral and pericentral power induced by OK over 2 years were not significantly correlated with concurrent changes in axial length of white European children.
Short- and Long-Term Changes in Corneal Aberrations and Axial Length Induced by Orthokeratology in Children Are Not Correlated
Jacinto Santodomingo-Rubido et al.
The study was conducted to assess the correlation between changes in corneal aberrations and the 2-year change in axial length in children fitted with orthokeratology contact lenses (ortho-K).
It was found short-term and long-term ortho-K lens wear induces significant changes in corneal aberrations that are not significantly correlated with changes in axial elongation after 2-years.
Long-term Efficacy of Orthokeratology Contact Lens Wear in Controlling the Progression of Childhood Myopia
Jacinto Santodomingo-Rubido, César Villa-Collar, Bernard Gilmartin, Ramón, Gutiérrez-Ortega & Keiji Sugimoto
The study was conducted over 7 years to compare the axial length growth of white European myopic children from 6 to12 years old wearing orthokeratology contact lenses (ortho-K) to a control group over a 7-year period. The axial length growth of ortho-K group was 33% slower than the on
The effects of entrance pupil centration and coma aberrations on myopic progression following orthokeratology
Jacinto Santodomingo Rubido et al.
The study was conducted in Spain to assess the potential association between entrance pupil location relative to the coaxially sighted corneal light reflex (CSCLR) and the progression of myopia in children fitted with orthokeratology (OK) and to investigate whether coma aberration induced by decentration of the entrance pupil centre relative to the CSCLR, as well as following OK treatment, is correlated with the progression of myopia. A significant increase in vertical coma was found with OK lens wear compared to baseline (p < 0.001) but total root mean square (RMS) coma was not associated with the change in axial length (all p > 0.05). Entrance pupil location relative to the CSCLR was not significantly affected by either OK lens wear or an increase in axial length. Greater magnitude coma aberrations found at the entrance pupil centre in comparison to the CSCLR might be attributed to centration of orthokeratological treatments at the CSCLR.
Effect of low-addition soft contact lenses with decentered optical design on myopia progression in children: a pilot study
Takashi Fujikado et al.
The pilot study was conducted to evaluate the effect of decentered optical design low-addition soft contact lenses for controlling myopia progression over 2 years. Control group wore monofocal soft contact lenses. As a result of this study, it was observed that the decentered optical design low-addition soft contact lenses was effective to suppress the axial elongation compared to control group, however, we did not find significant difference on refractive error.
The reduction of the progression of myopia by low-addition soft CLs warrants further investigations.
Factors Preventing Myopia Progression With Orthokeratology Correction
Jacinto Santodomingo-Rubido et al
The study was conducted in Spain to examine which baseline measurements constitute predictive factors for axial length growth over 2 years in children wearing orthokeratology contact lenses (ortho-k) and single-vision spectacles (SV). Orthokeratology is a successful treatment option in controlling axial elongation compared to SV in children of older age, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had lower myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris and pupil diameters, and had lower levels of parental myopia.
Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Refractive and Biometric Changes
Jacinto Santodomingo-Rubido et al
The study was conducted for 2 years in Spain, for the purpose of comparing axial length growth between white children with myopia wearing orthokeratology contact lenses (ortho-k) and distance single-vision spectacles (SV). The axial length growth was observed with both groups, however, that of SV group was significantly greater than ortho-k group. This result showed the ortho-k lowered the axial length growth and might be effective to control the myopia progression.
Open Access https://iovs.arvojournals.org/article.aspx?articleid=2168338
Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial
Pauline Cho; Sin-Wan Cheung
The study was conducted for 2 years in Hong Kong, for the purpose to evaluate the effectiveness of orthokeratology contact lenses (ortho-k), which is thought to be one of the means for the myopia progression control. One group was assigned to wear ortho-k, and the other to wear single-vision glasses as a control. As a result of measuring the axial length, the axial length elongation of ortho-k group was 43% slower than of the control group, so that the ortho-k might be effective to control the myopia progression.