Assessment of large-diameter and small-diameter SoftK specialty contact lenses for early-stage keratoconus.

INTRODUCTION: Soft contact lenses may be a good alternative for early-stage keratoconus (KC) patients who do not tolerate rigid gas permeable (RGP) lenses due to ocular discomfort or complications. This prospective study compared outcomes obtained after 2 weeks of wearing two types of soft silicone hydrogel contact lenses for keratoconus that varied in their diameter and central thickness (cc). METHODS: Patients with Amsler-Krumeich grades I or II KC were fitted with small-diameter (14.2 or 14.8 mm) SoftK (SD-SoftK, cc = 0.48 mm) and large-diameter (17 mm) SoftK (LD-SoftK, cc = 0.60 mm) lenses, each worn for 2 weeks in a crossover design. Low (10%;10VA) and high (100%;100VA) contrast visual acuity, contrast sensitivity (CS, Pelli-Robson), higher order aberrations (HOAs, Visionix Vx130), the number of trial lens modifications during fitting and the subjectively preferred lens were compared using Friedman tests with post-hoc analysis. RESULTS: Forty eyes (N = 20, 10 males, mean age: 39.0 ± 9.9 years, range: 23-55 years) were examined. Their habitual median (interquartile1, interquartile3) 10VA (LogMAR), 100VA (LogMAR) and CS (LogCS) were 0.52 (0.30, 0.50), 0.14 (0.10, 0.15) and 1.35 (1.35, 1.50), respectively. For the SD-SoftK condition, the values were 0.23 (0.17, 0.30), 0.02 (0.00, 0.05) and 1.50 (1.50, 1.65), respectively. For the LD-SoftK condition, the respective values were 0.36 (0.27, 0.44), 0.09 (0.05, 0.13) and 1.50 (1.50, 1.60). SD-SoftK lenses significantly improved 10VA compared with habitual and LD-SoftK. SD-SoftK also significantly improved CS compared with habitual, but not LD-SoftK. LD-SoftK significantly improved spherical aberration compared with uncorrected (0.03 ± 0.10 µ vs. 0.07 ± 0.13 µ) but not SD-SoftK (0.04 ± 0.07 µ). Both lenses required a mean of 1.5 modifications prior to final lens fitting. Fewer adverse events were seen with SD-SoftK (N = 3) compared with LD-SoftK (N = 8), and 75% of participants preferred SD-SoftK lenses. CONCLUSION: SD-SoftK lenses were preferred by 75% of subjects, were associated with fewer adverse events and significantly improved 10VA compared with LD-SoftK lenses. SD-SoftK lenses also significantly improved CS compared with the habitual correction, but this did not differ significantly from the LD-SoftK lenses.

Choroidal thickness assessment in keratoconus patients treated with cross-linking compared to healthy population.

PURPOSE: To analyze the choroidal thickness between patients with keratoconus undergoing cross-linking treatment and a healthy population, as well as to determine the factors that influence choroidal thickness. METHODS: This was an observational, analytical, case-control study that was conducted from February 2021 to June 2021. Choroidal thickness was measured at different locations, including the subfoveal, nasal (1000 µm), temporal (1000 µm), superior (1000 µm) and inferior (1000 µm) locations using a Spectral-domain optical coherence tomography with enhanced depth imaging, which allowed us to obtain horizontal and vertical B-scans centered on the fovea. RESULTS: This study included 21 patients with keratoconus (mean age, 21.86 ± 5.28 years) and 28 healthy patients (mean age, 24.21 ± 4.71 years). Choroidal thickness was significantly greater in patients with keratoconus than in healthy patients in each of the following measured locations: subfoveal (P < 0.001); nasal (1000 µm) (P < 0.001), temporal (1000 µm) (P < 0.001), superior (1000 µm) (P < 0.001) and inferior (1000 µm) (P < 0.001) locations. Variables such as age (ρ = - 0.09; P = 0.50) and refraction (ρ = 0.14; P = 0.34) were not found to be associated with choroidal thickness. In a stepwise multiple linear regression, the group was the single variable correlated with choroidal thickness (ß = 0.88; P < 0.001). CONCLUSION: Choroidal thickness is thicker in keratoconus patients treated with cross-linking than in the healthy population. This finding could be associated with inflammatory choroidal mechanisms in keratoconus patients, but more studies are needed. Age and refractive error do not seem to influence choroidal thickness.

ASSESSMENT OF CORNEAL ENDOTHELIAL LAYER IN CONTACT LENS WEARERS WITH THE AID OF AN ENDOTHELIAL MICROSCOPE.

AIMS: The main aim of our study was to demonstrate the difference in endothelial cell density between a group of keratoconus contact lens users and non-contact lens users (without keratoconus). MATERIAL AND METHODS: In our study we had data from 96 subjects with an average age of 40.5 ±14.05 years. For the purposes of our study, we worked with each eye separately for each subject (n = 192). Keratoconus (research group) was diagnosed in 97 eyes. The mean age of the patients in the research group was 41.9 ±10.6 years. Keratoconus was not diagnosed in the remaining 95 eyes (control group). The mean age of the patients in the control group was 39.5 ±16.6 years. In the keratoconus group, the patients wore hard contact lenses (HCL) in a total of 43 eyes, hybrid contact lenses (HbCL) in 48 eyes and soft contact lenses (SCL) in 6 eyes. The average total period of contact lens use in the research group was 10.6 ±2.36 years. RESULTS: The average number of endothelial cells in the research group was 2607.11 ±298.45 cells per mm2. The average number of endothelial cells in the control group was 2831.94 ±523.51 cells per mm2. We tested these two variables using a T-test, which showed a statistically significant difference (p < 0.001). A statistically significant difference in the mean endothelial cell count related to patient age and use / non-use of contact lenses of two types was demonstrated only in the under-40 group in a comparison of the non-contact and keratoconus group with the keratoconus group using HCL (p = 0.02). A statistically significant difference in the length of contact lens wear was demonstrated between the keratoconus-free group with or without SCL and the keratoconus group when wearing HCL or HbCL for more than 20 years (p = 0.01 and p = 0.02). For HbCL users, this difference was demonstrated also after 15 years of wearing (p = 0.001). CONCLUSION: From our results we can conclude that there is a difference in endothelial cell density between patients with and without keratoconus.

Assessment of the quality of information on treatment of keratoconus on YouTube.

PURPOSE: To evaluate the reliability, quality and effectiveness of YouTube videos addressing treatment of keratoconus. METHODS: This is a retrospective, cross-sectional and register-based study. A YouTube search was performed using the keyword treatment of keratoconus, and the first 100 videos that came out were included in the study. The numbers of views, likes, dislikes, comments, daily viewing rate (number of views per day), uploaded source (physicians, public or private institution, health channel or patients), country of origin, video type (patient experience, scholarly information), and described treatment technique (contact lens, corneal cross-linking, intrastromal corneal ring, topography-guided photorefractive keratectomy, keratoplasty) were evaluated for all videos. They were also evaluated regarding their DISCERN, Journal of the American Medical Association (JAMA), global quality score (GQS) and usefulness score by two independent ophthalmologists. RESULTS: Of the top 100 videos, 83 videos met the criteria. The mean DISCERN, JAMA, GQS and usefulness score were 42.92 ± 18.14, 2.7 ± 0.73, 3.07 ± 1.25 and 2.99 ± 1.44, respectively. Of the 83 videos, 35(42.2%) had been uploaded by physicians, 19(22.9%) by patients, 15(18.1%) by health channel, and 14(16.9%) by institutions/private health institutions. In the correlation analysis, the four scoring systems showed a statistically significant and strong positive correlation with each other (p < 0.001). In addition, viewing rate DISCERN, GQS, usefulness scores, number of likes, dislikes and comments showed a statistically significant positive correlation. CONCLUSION: The content of YouTube videos regarding treatment of keratoconus is of generally good quality and is educational for patients. Increasing the number of videos uploaded by healthcare professionals will increase the quality, reliability and informative features of the videos.

Contact Lens Fitting in Patients with Keratoconus - A Retrospective Assessment of 200 Patients. / Verlauf der Kontaktlinsenanpassung bei Keratokonus ­ eine retrospektive Untersuchung bei 200 Patienten.

BACKGROUND AND PURPOSE: Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes. PATIENTS AND METHODS: This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting. RESULTS: The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting. CONCLUSIONS: The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.

Assessment of YouTube videos as an information resource for keratoconus patients.

PURPOSE: To assess the quality of YouTube™ videos on keratoconus as an information resource for patients. METHODS: The words "Keratoconus", "Crosslinking", and "Keratoconus treatment for patients" were used as search terms on the official YouTube™ website (http://www.youtube.com). All cookies were disabled, the search history of the web browser was deleted just prior to the search, and no additional changes were made to the standard YouTube™ search preferences. The first 180 videos were downloaded. A total of 116 videos were evaluated according to DISCERN score, Journal of the American Medical Association score, and Global Quality Score. Videos were also assessed based on the presence or absence of 10 criteria proposed by two ophthalmologists. RESULTS: One hundred and sixteen videos were analyzed after the exclusion of 54 videos that were either duplicates, irrelevant, or in languages other than English. The mean DISCERN, Journal of the American Medical Association and Global Quality scores were 43.25±11.52, 1.30±0.90, 3.05±0.96 respectively. Fifty-six (48.3%) videos had been uploaded by physicians, 23 (19.8%) by healthcare organizations, 23 (19.8%) by patients, and 14 (12.1%) by other entities such as independent organizations and YouTube™ health channels. The most commonly satisfied criterion was information on treatment modalities (82.7%). CONCLUSION: Keratoconus is a disease of youth, therefore YouTube™ videos would seem to be an easily accessible, informative and educational source, especially for younger patients. However, these videos are not useful as information resources and overall do not offer any additional benefit to patients.

Economic impact of keratoconus using a health expenditure questionnaire: A patient perspective.

IMPORTANCE: This is the first study to estimate the lifetime costs associated with keratoconus based on a questionnaire completed by patients and highlights the significant economic burden of the disease. As keratoconus affects individuals from a young age, the study highlights keratoconus as a public health concern. BACKGROUND: Keratoconus is a disorder characterized by corneal steepening and thinning, leading to reduced visual acuity. To date, there have been no studies evaluating the economic costs of keratoconus from a patient's perspective. DESIGN: A randomized cross-sectional study undertaken in Australia where keratoconus subjects were recruited from public and private ophthalmology and optometry clinics. PARTICIPANTS: A total of 100 participants completed the questionnaire: median age was 31 years and 57% were males. METHODS: A keratoconus health expenditure questionnaire was designed to assess direct and indirect expenditures for each individual. MAIN OUTCOME MEASURES: Total direct and indirect costs associated with the condition were calculated along with the estimated lifetime per capita costs. RESULTS: The total cost related to direct and indirect care was estimated to be AUD 3365. By applying our cost data to keratoconus prevalence data for the Australian population, the total cost is estimated to be approximately AUD 44.7 million per year in Australia. CONCLUSIONS AND RELEVANCE: Our results show that the costs associated with the diagnosis and management of keratoconus represent a significant cost to patients. An understanding of this is important not only to individuals and their families, but also health care providers, health insurers and the wider health system.

Crosslinking corneano para ceratocone / Crosslinking corneano para ceratocone

Contexto: O ceratocone consiste em doença degenerativa do olho com incidência de 1 caso a cada 2.000 pessoas, que ocasiona deformidade da córnea e progressiva perda da acuidade visual, com impacto na qualidade de vida do paciente. O crosslinking consiste em procedimento terapêutico minimamente invasivo que visa bloquear a evolução do ceratocone, prevenindo ou adiando a realização de transplante de córnea. Aumenta a força biomecânica pela fotopolimerização altamente localizada do estroma corneal. Este procedimento não é ofertado pelo SUS, no entanto, tem sido utilizado por várias instituições privadas no país. Esta realidade tem gerado demanda crescente de solicitação de crosslinking ao sistema público, tanto por via administrativa, quanto judicial. Pergunta: Qual a efetividade do crosslinking corneano na estabilização do ceratocone e prevenção de piora progressiva da acuidade visual? Evidências científicas: Foram identificados 152 estudos sendo que, após a seleção, oito foram incluídos neste parecer: três revisões sistemáticas (duas com metanálise), quatro ensaios clínicos controlados randomizados e um controlado não randomizado.Foram identificadas 5 avaliações de tecnologia em saúde, sendo três do Canadá, uma da Argentina e uma da Suécia. A revisão da literatura demonstrou que o crosslinking corneano é um procedimento efetivo na \r\nestabilização do ceratocone, bloqueando sua progressão que é evidenciada pelas medidas de curvatura da córnea (nível moderado de evidência pelo GRADE e desfecho classificado como importante). Dos oito estudos, sete demonstraram redução das medidas da ceratometria (Kmax e/ou Kmed) nos pacientes submetidos a crosslinking, com diferença estatisticamente significativa em relação ao pré-operatório e ao grupo controle. A acuidade visual, desfecho crítico, também apresentou nível moderado de evidência a favor do \r\ncrosslinking. Apenas um estudo analisou ocorrência de transplante de córnea no acompanhamento de casos e controles. Todos os estudos negaram ocorrência de eventos adversos ou complicações graves ou permanentes. A análise das cinco avaliações de tecnologia em saúde sobre crosslinking evidenciou que, de forma geral, foram cautelosas na indicação do procedimento. Discussão: O crosslinking corneano é um \r\nprocedimento minimamente invasivo, de baixo custo e com risco reduzido de complicações. Há evidências de nível moderado sobre a sua eficácia na estabilização do ceratocone pelo acompanhamento das medidas de curvatura da córnea e de acuidade visual. Além disso, deve ser levada em consideração a possibilidade de que com o tratamento sendo feito no ínicio da doença ocorrer uma diminuição da quantidade de transplantes de córnea. Em 2014 o SUS realizou 4.234 transplantes de córnea em consequência do Ceratocone, representando no SUS 31% dos casos de transplantes de córnea e um investimento de R$8.764.380,00 \r\n(dados do CID - Classificação Internacional de Doenças). Decisão: Incorporar o crosslinking corneano para o tratamento da ceratocone, no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria SCTIE-MS nº 30 \r\npublicada no Diário Oficial da União (DOU) nº 183, de 22 de setembro de 2016.

Assessment of a Novel Corneal-Shaping Device With Simultaneous Corneal Collagen Cross-Linking Using a Porcine Eye Model.

PURPOSE: Corneal collagen cross-linking (CXL) alone cannot substantially improve refractive errors. We designed a novel corneal-shaping device, showing that a prototype applied during CXL can alter corneal curvature to a greater extent than CXL alone in a porcine eye model. METHODS: The device prototype was made with flat, UV-transmissible material. Enucleated porcine eyes were deepithelialized and perfused. Preexperimental and postexperimental corneal curvature (K) measurements and Anterior Segment Optical Coherence Tomography imaging were performed. A conventional CXL protocol was followed. Six experiments of 6 treatment groups in duplicate were performed (n = 12/group): (A) no CXL + no device, (B) no CXL + 30 minutes device, (C) 10 minutes, CXL + no device, (D) 10 minutes, CXL + device, (E) 30 minutes, CXL + no device, and (F) 30 minutes, CXL + device. RESULTS: There was a significant decrease (P < 0.001) in corneal curvature after 30 minutes. CXL between group F (-1.54 ± 0.90 D) and groups E (+0.34 ± 0.53 D), B (+0.69 ± 1.02 D), or A (+0.22 ± 1.24 D). The demarcation line depth was greater in group F (34% ± 4%) than group D (30% ± 4%, P < 0.05). Groups D (-2.3% ± 21%) and F (0.24% ± 15%) had less change in corneal thickness than in control groups A (15% ± 12%, P < 0.05) and E (12% ± 11%, P < 0.05). CONCLUSIONS: Application of our corneal-shaping device during CXL significantly decreased corneal curvature compared with controls. Anterior Segment Optical Coherence Tomography imaging showed comparable extent of cross-linking in eyes treated ± device. This demonstrates that our novel device used during CXL may further promote corneal strengthening and refractive correction in patients.

Protocolo de uso da radiação para cross-linking corneano no tratamento do ceratocone / Use protocol from radiation to corneal cross-linking in the treatment of keratoconus

A presente proposta de Protocolo de Uso da Radiação para Crosslinking Corneano no Tratamento do Ceratocone foi desenvolvidas pela CGMAC/DAET/SAS tendo em vista a recomendação feita pela CONITEC na ocasião de sua 47ª reunião e a subsequente decisão da Secretaria de Ciência e Tecnologia do Ministério da Saúde de incorporar o crosslinking corneano para o tratamento da ceratocone, no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria SCTIE-MS nº 30 publicada no Diário Oficial da União (DOU) nº 183, de 22 de setembro de 2016. Os membros da CONITEC presentes na reunião do plenário, realizada nos dias 9 e 10° de setembro de 2016, deliberaram para que o tema fosse submetido à consulta pública com recomendação preliminar favorável. A matéria será disponibilizada em Consulta Pública a fim de que se considere a visão da sociedade e se possa receber as suas contribuições. A consulta pública foi realizada entre os dias 05/12/2016 e 26/12/2016. Foram recebidas 4 contribuições. Dentre as 4 contribuições, 3 apenas classificavam o protocolo como muito bom e apenas 1 apresentou contribuição textual, a qual segue transcrita: "Gostaria que o texto informasse quais seriam os critérios técnicos da indicação do crosslinking. Por exemplo, segundo o consenso global de ceratocone a progressão de cerarotocone deve ser considerada avaliando a face posterior da córnea por meio da tomografia corneana. Mas nem todos os serviços no SUS possui a Tomografia. É preciso que esta tecnologia seja bem definida para quem será o responsável prinicipal da realização deste procedimento. Por exemplo, comprovante de especialização em Córnea após realização dos 3 anos de especialização em Oftalmologia". Avaliação: No Protocolo de Uso, a indicação está assim especificada: "O principal objetivo do crosslinking é conter a progressão do ceratocone. Logo, o melhor candidato ao tratamento é o indivíduo com sinais claros de progressão da doença. Atualmente não existem critérios definitivos para estabelecer a progressão do ceratocone, porém os parâmetros a serem considerados são a mudança do erro refrativo, piora da acuidade visual, bem como progressão nos valores encontrados nas topografias e tomografias da córnea." Todos os procedimentos minimamente necessários para o diagnóstico e acompanhamento de caso de ceratocone estão especificados no item Diagnóstico do Protocolo de Uso e disponíveis na Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Materiais Especiais do SUS, não sendo, assim, a tomografia um exame obrigatório nem indispensável. No procedimento criado, os seguintes atributos estarão especificados: Serviço/Classificação: 131 - Serviço de Oftalmologia 033 ­ Tratamento cirúrgico do aparelho da visão e CBO: 225265 ­ Médico Oftalmologista. Competirá aos gestores estaduais, distrital e municipais do SUS, conforme a sua competência e pactuações, estruturar a rede assistencial, definir os serviços referenciais e estabelecer os fluxos para o atendimento dos indivíduos com a doença em todas as etapas descritas no Protocolo de Uso. Para tal, devem observar os critérios para credenciamento e habilitação em oftalmologia, inclusive quanto a recursos humanos, definidos na Portaria Nº 288/SAS/MS, de 19 de maio de 2008. Deliberação final: Aos 12 (doze) dias do mês de janeiro de 2017, membros da CONITEC deliberaram por unanimidade recomendar a aprovação do do "Protocolo de uso da radiação para crosslinking Corneano no tratamento do ceratocone". Foi assinado o Registro de Deliberação n˚ 232/2017.

Quantitative assessment of UVA-riboflavin corneal cross-linking using nonlinear optical microscopy.

PURPOSE: Corneal collagen cross-linking (CXL) by the use of riboflavin and ultraviolet-A light (UVA) is a promising and novel treatment for keratoconus and other ectatic disorders. Since CXL results in enhanced corneal stiffness, this study tested the hypothesis that CXL-induced stiffening would be proportional to the collagen autofluorescence intensity measured with nonlinear optical (NLO) microscopy. METHODS: Rabbit eyes (n = 50) were separated into five groups including: (1) epithelium intact; (2) epithelium removed; (3) epithelium removed and soaked in riboflavin, (4) epithelium removed and soaked in riboflavin, with 15 minutes of UVA exposure; and (5) epithelium removed and soaked in riboflavin, with 30 minutes of UVA exposure. Corneal stiffness was quantified by measuring the force required to displace the cornea 500 µm. Corneas were then fixed in paraformaldehyde and sectioned, and the collagen autofluorescence over the 400- to 450-nm spectrum was recorded. RESULTS: There was no significant difference in corneal stiffness among the three control groups. Corneal stiffness was significantly and dose dependently increased after UVA (P < 0.0005). Autofluorescence was detected only within the anterior stroma of the UVA-treated groups, with no significant difference in the depth of autofluorescence between different UVA exposure levels. The signal intensity was also significantly increased with longer UVA exposure (P < 0.001). Comparing corneal stiffness with autofluorescence intensity revealed a significant correlation between these values (R(2) = 0.654; P < 0.0001). CONCLUSIONS: The results of this study indicate a significant correlation between corneal stiffening and the intensity of collagen autofluorescence after CXL. This finding suggests that the efficacy of CXL in patients could be monitored by assessing collagen autofluorescence.

[Efficacy and low cost in keratoconus treatment with rigid gas-permeable contact lens]. / Eficácia e baixo custo no tratamento do ceratocone com o uso de lentes de contato rígidas gás-permeáveis.

PURPOSE: To study the efficacy of rigid gas-permeable contact lens (RGPCL) fitting in keratoconus patients and to determine treatment costs. METHODS: The records of 126 patients treated at the Hospital das Clínicas de Ribeirão Preto from January 2001 to June 2002 were retrospectively studied. Information about sex, age and treated eyes was collected. Visual acuity (VA) with and without correction was measured and plotted against corneal base curve (K) and toricity. Average price of the lenses was calculated. RESULTS: Fitting rigid gas-permeable contact lens was successful in 86.18% of the patients, resulting in VA=0.8 in 40.00% of them. Visual acuity improvement was observed in patients with steep base curve and in patients with high corneal toricity. Age of most patients ranged from 15 to 45 years; 60.31% of them were female. Corneal transplantation was indicated in 11.24% of the cases. Cost of each lens averaged R$ 40.00 (USD 13.00). CONCLUSION: Rigid gas-permeable contact lens proved to be an efficient, low-cost resource for improving visual acuity in most of the treated patients.

Eficácia e baixo custo no tratamento do ceratocone com o uso de lentes de contato rígidas gás-permeáveis / Efficacy and low cost in keratoconus treatment with rigid gas-permeable contact lens

OBJETIVO: Avaliar a eficácia da adaptação de lente de contato rígida gás-permeável (LCRGP) em pacientes com ceratocone e os custos do tratamento. MÉTODOS: Realizou-se análise retrospectiva dos prontuários de 126 pacientes atendidos no Ambulatório de Lente de Contato do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto no período de janeiro de 2001 a junho de 2002. Foram analisados sexo, idade e número de olhos adaptados. A acuidade visual sem e com correção foi relacionada à curva-base em K (meridiano mais plano da córnea) do paciente e à diferença ceratométrica dos meridianos corneanos. Determinou-se o custo unitário médio das lentes fornecidas aos pacientes. RESULTADOS: Obteve-se sucesso na adaptação de lente de contato rígida gás-permeável em 86,19 por cento dos casos, com visão = 0,8 em 40,00 por cento dos pacientes adaptados. Houve melhora visual tanto nos pacientes com curva-base elevada quanto naqueles que apresentavam alta diferença ceratométrica entre os meridianos corneanos. A faixa etária mais acometida encontrou-se entre 15 e 45 anos, sendo 60,31 por cento dos pacientes do sexo feminino. A proporção de indicação de transplante de córnea foi de 11,42 por cento. O custo unitário médio da lente foi de R$ 40,00. CONCLUSAO: A adaptação proporcionou acentuada melhora visual na maioria dos pacientes portadores de ceratocone a custo relativamente baixo.

Vision care benefits and outcomes of treatment of keratoconus.

Coverage for basic vision care services is offered by a number of national and regional vision care networks. When eyewear is covered, cosmetic contact lenses are usually provided in lieu of glasses. There are a few disorders for which contact lenses are prescribed for a "medically necessary" condition; keratoconus is an example. Some plans provide full benefits for noncosmetic contact lenses for the treatment of keratoconus, and outcomes measures have demonstrated that visual improvement has been excellent. Evidence of the vision benefit offered to those with keratoconus is found in patient-satisfaction surveys, which provide self-reports of improvements in near and distance vision.

[Contact lenses: indications and limits]. / Kontaktlinsen: Indikationen und Grenzen.

Contact lens wear may be indicated for cosmetic, professional, optical or therapeutic reasons. For each of these indications the arguments are given, why and when contact lenses are better than spectacle correction and which possibilities there are. Contact lens wear is contraindicated in certain eye diseases and in the case of problems of handling and hygiene. The author's preferences concerning the different contact lens materials are summarized briefly.