Corneal Response to Scleral Contact Lens Wear in Keratoconus.

OBJECTIVE: To verify corneal alterations in patients with keratoconus who wear scleral contact lenses (ScCLs), focusing on corneal endothelial assessment. METHODS: Scleral contact lenses were fitted in 22 patients with keratoconus. During a 90-day follow-up, patients were assessed in three visits: at baseline, after 30 days, and after 90 days. Patients underwent visual acuity measurement, slitlamp biomicroscopy of the anterior segment, specular microscopy of the corneal endothelium, corneal pachymetry, measurement of the clearance between the cornea and the lens, and follow-up of ectasia. RESULTS: Variables related to endothelial morphology and pachymetry values did not change significantly over time. Central clearance measurements decreased in the 90-day period. No progression of corneal ectasia was observed, neither were infectious or inflammatory processes in the same period. CONCLUSION: Daily wear of ScCLs in patients with keratoconus was not associated with adverse effects on the cornea or endothelium over a period of 90 days nor was there evidence of disease progression. Central clearance values diminished over that period, but the significance of this observation remains unclear.

Clinical experience with adjustable scleral lenses.

PURPOSE: The aim of this study was to evaluate the fitting process of a scleral lens that allows several parameter adjustments during trials and after the initial period of use. In addition, we verified which adjustments were needed and used the most, their indications, and how often these resources were used, and checked the results. METHODS: Scleral contact lens fittings in a private clinic setting were prospectively analyzed in a sequential, non-randomized, and non-comparative manner. All the patients underwent a complete ophthalmic examination and had an indication for scleral lens use (Zenlens, Alden Optical). RESULTS: Scleral fit was analyzed in 80 eyes of 45 patients. Regarding diagnosis, 72% of the patients had keratoconus; 12%, radial keratotomy; 5%, post-refractive surgery ectasia; 5%, dry eye; and 3%, high myopia. In 66 (82.5%) of the 80 eyes studied, parameters were modified when the lenses were ordered. The reasons that led to the modifications were apical touch or decreased sagittal height, increased sagittal height, cylindrical over-refraction, poor visual acuity, lens flexure, peripheral touch, 360° edge compression, horizontal edge compression, and vertical edge compression. CONCLUSION: In this study, the use of Zenlens scleral lenses was shown to be a promising corrective treatment for patients requiring the use of scleral lenses. Although the study suggests a learning curve, as many adjustments were allowed, the lens could be customized according to the patients' needs. This increased the success rates of fitting and wearing, and consequently, use of the lens became a great option for the visual rehabilitation of patients.

Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update.

PURPOSE: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. METHODS: 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. RESULTS: Of the 1336 respondents, concern was highest (9.0 ±â€¯1.6; p < 0.001) in Asia and lowest (7.6 ±â€¯2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ±â€¯2.3; p < 0.001), the North American practitioners being the least active (6.3 ±â€¯2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ±â€¯21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). CONCLUSIONS: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.

[Contact lens in children: epidemiological aspects]. / Lente de contato em crianças: aspectos epidemiológicos.

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6%) were male and 39 (53.4%) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9%) cases. Keratoconus was present in 14 (19.1%), leucoma in 11 (15%), anisometropia in 10 (13.7%), refractive errors in 9 (12.3%), irregular astigmatism in 7 (9.5%), ectopia lentis in 4 (5.4%), high myopia in one case (1.3%) and one child (1.3%) had no ocular pathology, just wishing to change eye color. 52 (71.2%) had medical indication, 9 (12.3%) had optical indication and 12 (16.4%) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7%), soft lens in 41 (39.8%) and cosmetic soft lens in 11 (10.6%). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Clinical experience with adjustable scleral lenses / Experiência clínica com lentes esclerais ajustáveis

ABSTRACT Purpose: The aim of this study was to evaluate the fitting process of a scleral lens that allows several parameter adjustments during trials and after the initial period of use. In addition, we verified which adjustments were needed and used the most, their indications, and how often these resources were used, and checked the results. Methods: Scleral contact lens fittings in a private clinic setting were prospectively analyzed in a sequential, non-randomized, and non-comparative manner. All the patients underwent a complete ophthalmic examination and had an indication for scleral lens use (Zenlens, Alden Optical). Results: Scleral fit was analyzed in 80 eyes of 45 patients. Regarding diagnosis, 72% of the patients had keratoconus; 12%, radial keratotomy; 5%, post-refractive surgery ectasia; 5%, dry eye; and 3%, high myopia. In 66 (82.5%) of the 80 eyes studied, parameters were modified when the lenses were ordered. The reasons that led to the modifications were apical touch or decreased sagittal height, increased sagittal height, cylindrical over-refraction, poor visual acuity, lens flexure, peripheral touch, 360° edge compression, horizontal edge compression, and vertical edge compression. Conclusion: In this study, the use of Zenlens scleral lenses was shown to be a promising corrective treatment for patients requiring the use of scleral lenses. Although the study suggests a learning curve, as many adjustments were allowed, the lens could be customized according to the patients' needs. This increased the success rates of fitting and wearing, and consequently, use of the lens became a great option for the visual rehabilitation of patients.

RESUMO Objetivo: Avaliar o processo de adaptação de uma lente escleral que permite vários ajustes de parâmetros durante os testes e após o período inicial do seu uso; verificar quais os ajustes foram necessários, quais foram os mais utilizados, as suas indicações, a frequência com que estes recursos foram utilizados, e avaliar os resultados das mudanças realizadas. Métodos: A adaptação da lente de contato escleral foi analisada prospectivamente, de forma sequencial, não aleatória e não comparativa. Todos os pacientes foram submetidos a um exame oftalmológico completo e tinham indicação para o uso de lentes esclerais. Foi utilizada a lente Zenlens (Alden Optical). Resultados: Foi analisada a adaptação de lentes de contato esclerais em 80 olhos de 45 pacientes. Quanto ao diagnóstico, 72% tinham ceratocone, 12% tinham sido submetidos a ceratotomia radial, 5% tinham ectasia pós-cirurgia refrativa, 5% tinham olho seco, e 3%, alta miopia. Em 66 dos 80 olhos estudados (82,5%), os parâmetros foram modificados quando as lentes foram encomendadas. As razões foram: toque apical ou diminuição da altura sagital, aumento da altura sagital, sobre-refração cilíndrica, baixa acuidade visual, flexão da lente, toque periférico, compressão da borda em 360° e compressão da borda horizontal e/ou vertical. Conclusão: O uso de lentes esclerais Zenlens demonstrou ser uma forma de correção muito promissora para os pacientes que requerem o uso de lentes esclerais. Embora o estudo sugira uma curva de aprendizagem, é possível personalizar as lentes de acordo com as necessidades de cada pacientes. Este fato melhora a adaptação e aumenta a chance de sucesso do uso.

Corneal changes and wavefront analysis after orthokeratology fitting test.

PURPOSE: To evaluate corneal changes and ocular aberrations during an orthokeratology test. DESIGN: A prospective, nonrandomized cohort study. METHODS: Fourteen myopic patients (26 eyes) underwent an orthokeratology fitting test with the BE contact lens (Ultravision Pty, Ltd, Brisbane, Australia). Best spectacle-corrected visual acuity (BSCVA), uncorrected (Ultravision Pty, Ltd, Brisbane, Australia) visual acuity (UCVA), subjective cycloplegic refraction, biomicroscopy, corneal topography, optical pachymetry, and aberrometry were performed at baseline and one and eight nights orthokeratology. The short-term effect of orthokeratology using corneal topography, tomography, and ocular aberrations was evaluated. RESULTS: The mean spherical equivalent changed from -2.24 +/- 0.98 diopters (D) at baseline to 0.15 +/- 0.76 D after the eight nights of lens wear (P = .001). All patients had an UCVA of 20/30, 69.2% with 20/20. Changes in central corneal pachymetry were not observed. There was a statistically significant increase in the temporal corneal thickness from night one, without any difference between nights one and eight (P > .001). A significant increase of higher-order root mean square values was observed from baseline (0.42 +/- 0.16 mum), night one (0.81 +/- 0.24 mum), and night eight (1.04 +/- 0.24 mum). Increases in coma (Z7+Z8) and spherical aberration (Z12) were observed. Positive horizontal (Z8) coma increased in right eyes, and negative horizontal (Z8) coma increased in left eyes (P < .001). CONCLUSIONS: Myopia reduction resulting from rapid central corneal flattening and improvement of UCVA occurred after orthokeratology. Higher-order aberrations (HOAs), particularly spherical aberration and coma, increased significantly during the orthokeratology test. An increase of temporal pachymetry and differences in coma direction induced between the eyes may be related to the subclinical lens decentration temporally.

Stability of wavefront aberrations during the daytime after 6 months of overnight orthokeratology corneal reshaping.

PURPOSE: To evaluate the stability of wavefront aberrations during the daytime after 6 months of overnight orthokeratology corneal reshaping. METHODS: A prospective study of 26 eyes using the Ultravision BE lens design during 6 months of overnight wear. Uncorrected visual acuity (UCVA), cycloplegic refraction, and wavefront aberrometry were measured at 8 AM (within 1 hour after awakening and removing lenses), 1 PM (5 to 6 hours after lens removal), and 6 PM (10 to 12 hours after lens removal). RESULTS: There was no significant difference in UCVA between 8 AM, 1 PM, and 6 PM (P=.383). Spherical power from wavefront aberrometry showed significant regression from 8 AM to 1 PM (P<.001) and stabilized near zero diopters. Total root-mean-square (RMS) increased and higher order aberration RMS and defocus (Z4) decreased between 8 AM and 1 PM (P<.001) but did not change for the rest of the day (P>.001). There was no statistically significant change in astigmatism (Z3 and Z5) (P=.449) and coma (Z7 and Z8) (P=.145) between 8 AM, 1 PM, and 6 PM. Spherical aberration (Z12) showed regression throughout the day (P<.001). CONCLUSIONS: After 6 months of overnight orthokeratology wear, some optical aberrations showed regression during the day. Despite no significant change in UCVA during 10 to 12 hours, there was a significant increase in defocus (Z4) within the first 5 hours after removing the orthokeratology lens and a decrease in spherical aberration (Z12) throughout the day.

[Hybrid material contact lens in keratoconus and myopic astigmatism patients]. / Lente de contato de material híbrido em pacientes com ceratocone e astigmatismo miópico composto.

PURPOSE: To evaluate comfort and visual performance in relation to two different used contact lens types: hybrid material (HM) and rigid-gas-permeable (RGP), in patients with regular myopic astigmatism and with keratoconus. METHODS: A randomized, double masked, prospective study of 22 patients with the diagnosis of myopic astigmatism (8 with myopic astigmatism and 14 with keratoconus) was conducted. Fifteen patients were female and 7 were male, and mean age was: 32.13 +/- 8.12 years. In one of the eyes a rigid-gas-permeable contact lens was adapted (DK 30), and in the other a hybrid material contact lens was adapted (DK 23). All patients were submitted to the following tests: measurement of comfort level by means of the analogical visual scale, tear break-up time, best corrected visual acuity with the Bailey-Lovie scale adapted for 4 meters, functional acuity contrast test (FACT) and wavefront analysis. RESULTS: In relation to comfort, there was no association with the evaluated contact lens type (p=0.350). There was a variation in comfort level during the first 7 days. The visual acuity increased between the 7th and the 15th day of adaptation. Visual acuity stabilized right after this period. The visual acuity did not show differences in relation to the studied lens type. It was verified that there was no difference in the tear break-up time (p=0.989) in relation to the studied lenses type and there was a decrease in the tear break-up time (p=0.001) when we compared the measurement before the use of the lenses and 2 months after their use. There was no difference in contrast sensitivity in the used lens type and between each type and the use of glasses (p<0.047). High order aberrations decreased significantly when comparing patients with and without contact lenses, except for spherical and coma aberrations (p=0.394). CONCLUSION: Comfort and visual performance when comparing hybrid material and rigid-gas-permeable contact lenses did not show any significant difference in the patients or when compared separately in regular myopic astigmatism and in keratoconus patients.

[Comparative analysis of visual function and the quality of life index with eyeglasses or a progressive contact lens]. / Comparação da função visual e do índice de qualidade de vida com uso de óculos ou de lente de contato progressiva.

PURPOSE: To compare the visual function and the answers to a questionnaire of quality of life of patients wearing a progressive contact lens or eyeglasses. METHODS: The Focus Progressive contact lens had been fitted in 35 patients with far visual acuity with progressive-addition eyeglasses equal to zero (log MAR) and near J1 (Jaeger). The far and near visual acuities and the measurement of contrast sensitivity were compared when the patients were wearing the eyeglasses or the contact lens and the patients' results of the scores of the quality of life questionnaire (NEI VFQ-25) were analyzed statistically considering the type of ametropy and the age. RESULTS: The far and near visual acuities and the contrast sensitivity measurement were worse with the contact lens than with eyeglasses. The answers to the questionnaire did not differ when were comparing the same patients wearing eyeglasses or contact lens, no matter the type of ametropy. The myopic and the hyperopic subgroups had worse answers to the quality of life questionnaire when corrected with the contact lens than with eyeglasses, both with age equal to or less than their median. CONCLUSIONS: The visual function was worse with the contact lens. The type of ametropy did not influence the answers to the quality of life questionnaire considering the optical correction, but age did.

[Keratoconus special soft contact lens fitting]. / Adaptação de lente de contato gelatinosa especial para ceratocone.

PURPOSE: To evaluate the fitting and use of a soft contact lens in keratoconic patients. METHODS: Retrospective study on 80 eyes of 66 patients, fitted with a special soft contact lens for keratoconus, at the Contact Lens Section of UNIFESP and private clinics. Keratoconus was classified according to degrees of disease severity by keratometric pattern. Age, gender, diagnosis, keratometry, visual acuity, spherical equivalent (SE), base curve and clinical indication were recorded. RESULTS: Of 66 patients (80 eyes) with keratoconus the mean age was 29 years, 51.5% were men and 48.5% women. According to the groups: 15.0% were incipient, 53.7% moderate, 26.3% advanced and 5.0% were severe. The majority of the eyes of patients using contact lenses (91.25%) achieved visual acuity better than 20/40. To 88 eyes 58% were tihed with lens with spherical power (mean -5.45 diopters) and 41% with spherocylinder power (from -0.5 to -5.00 cylindrical diopters). The most frequent base curve was 7.6 in 61% of the eyes. The main reasons for this special lens fitting were due to reduced tolerance and poor fitting pattern achieved with other lenses. CONCLUSION: The special soft contact lens is useful in fitting difficult keratoconic patients by offering comfort and improving visual rehabilitation that may allow more patients to postpone the need for corneal transplant.

[Refractional astigmatism prevalence and its relationship with grating acuity in children 2 to 36 months of age]. / Prevalência de astigmatismo refracional e sua relação com a acuidade visual de resolução em crianças de 2 a 36 meses.

PURPOSE: To evaluate refractional astigmatism prevalence and its relationship with grating acuity in a cohort of non-verbal children. METHODS: 482 normal children, aged from 2 to 36 months, were submitted to ophthalmological examination. Fourteen subjects were excluded due to ocular disease and the sample remained with 468 subjects (936 eyes); 230 (49%) males e 238 (51%) females. Grating acuity was assessed binocularly and monocularly with Teller acuity cards. All children underwent eye examination including cycloplegic retinoscopy and fundus by indirect ophthalmoscopy. RESULTS: Astigmatism was found in 222 (47.43%) of the children, with the hyperopic and with the rule types most frequently found in all ages. Concerning magnitude, this condition was equal or greater than 1.00 cylindric diopter in 24.35% of the children; equal or greater than 2.00 cylindric diopter in 5.55%; lower than 1.00 in 26.92% and between 1.00 and 2.00 in 18.73%. Grating acuity was normal in 219 of the subjects, despite magnitude, type and orientation of astigmatism. CONCLUSION: Visual acuity assessed by the acuity card procedure was not influenced by astigmatism.

Contact lens fitting in a patient with Alport syndrome and posterior polymorphous corneal dystrophy: a case report.

Alport Syndrome is a hereditary disease that is caused by a gene mutation and affects the production of collagen in basement membranes; this condition causes hemorrhagic nephritis associated with deafness and ocular changes. The X-linked form of this disease is the most common and mainly affects males. Typical ocular findings are dot-and-fleck retinopathy, anterior lenticonus, and posterior polymorphous corneal dystrophy. Some cases involving polymorphous corneal dystrophy and corneal ectasia have been previously described. Here we present a case report of a 33-year-old female with Alport syndrome, posterior polymorphous corneal dystrophy, and irregular astigmatism, whose visual acuity improved with a rigid gas permeable contact lens.

The use of ocular anatomical measurements using a rotating Scheimpflug camera to assist in the Esclera® scleral contact lens fitting process.

PURPOSE: To test for associations between Pentacam(®) derived topography variables and to evaluate the predictive power of those variables in relation to scleral contact lens (SCL) fit. SETTING: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo-SP, Brazil. DESIGN: Prospective observational non-randomised, non-comparative study. METHODS: Forty-seven patients (63 eyes) were indicated for the use of Esclera(®) SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam: corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable. RESULTS: In the total group, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm), with p<0.001 each. In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p<0.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p<0.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p=0.003). CONCLUSION: There was a positive correlation between the LSD and ACD, even as LD and ACD in the keratoconus group. Thus, these results suggest that certain Pentacam measurements can be good predictors of the most appropriate Esclera lens to be fitted in keratoconus patients.

Descriptive analysis of the type and design of contact lenses fitted according to keratoconus severity and morphology.

PURPOSE: Keratoconus is characterized by bilateral asymmetrical corneal ectasia that leads to inferior stromal thinning and corneal protrusion. There is currently a lack of consensus regarding the most efficacious method for fitting contact lenses in patients with keratoconus, given the various topographical patterns and evolution grades observed in affected populations. The purpose of the present study was to evaluate the association between keratoconus evolution grade and topography pattern and the type and design of fitted contact lens. METHODS: We performed a retrospective analysis of contact lenses fitted in a total of 185 patients with keratoconus (325 eyes). Keratoconus was classified as either grade I, II, III, or IV based on keratometry and cone morphology (nipple, oval, globus, or indeterminate) results. RESULTS: A total of 325 eyes were evaluated in the present study. Of the 62 eyes classified as grade I, 66.1% were fitted with monocurve contact lenses. Of the 162 eyes classified as grade I and II, 51%, 30%, and 19% were fitted with adapted monocurve rigid gas-permeable contact lenses (RGPCL), bicurve lenses, and others lens types, respectively. Bicurve lenses were fitted in 52.1% and 62.2% of eyes classified as grade III and IV, respectively. Of the eyes classified as grade III and IV, monocurve and bicurve RGPCL were fitted in 26% and 55%, respectively. In eyes with oval keratoconus, 45%, 35%, and 20% were fitted with monocurve lenses, bicurve lenses, and other lens types, respectively. In eyes with round cones (nipple morphology), 55%, 30%, and 15% were fitted with bicurve lenses, monocurve lenses, and other lens types, respectively. CONCLUSION: Monocurve RGPCL were most frequently fitted in patients with mild to moderate keratoconus and oval cones morphology, while bicurve lenses were more frequently fitted in patients with severe and advanced keratoconus. This was probably because bicurve lenses are more appropriate for round cones due to increased corneal asphericity.

Global trends in myopia management attitudes and strategies in clinical practice.

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% 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 (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

[Contact lens fitting after refractive surgery]. / Adaptação de lentes de contato após cirurgia refrativa.

PURPOSE: To evaluate the fitting and use of contact lens in patients submitted to refractive surgery. METHODS: This was a retrospective study in 53 patients submitted to refractive surgery who later started to use contact lens, from 1999 to 2003. The parameters were: previous ametropia, refractive surgery procedure, ametropia after surgery, postoperative spherical equivalent, postoperative keratometry, base curve of fitted contact lens, contact lens design, final visual acuity with spectacles after surgery, final visual acuity with contact lens, complications and the reason for stopping the use. The follow-up of patients ranged from 1 month to 84 months (average of 42.5 months). RESULTS: Of 53 evaluated patients, 19 patients had undergone LASIK (Laser Assisted in Situ Keratomileusis), 29 patients had undergone RK (radial keratotomy), 4 patients had undergone PRK (photorefractive keratectomy) and in one patient it was not possible to know which surgery was performed. 61.29% of the patients (57 eyes of a total of 93 eyes) were fitted with rigid gas-permeable lenses. There was an improvement of visual acuity in 60.21% of the cases (VA>20/40), with few complications. CONCLUSION: Due to the great number of performed refractive surgery, an increase in the number of patients unhappy with the postoperative result is expected, and for these patients, many times the use of contact lens is the best option. The fitting of contact lenses after refractive surgery demands knowledge, dedication and has good results principally regarding better visual acuity.

[Keratoconus: prognosis factors]. / Ceratocone: fatores prognósticos.

PURPOSE: To study keratoconus disease carrier patients in an age range under the usual one and try to detect any factor which can influence in disease evolution and prognosis. METHODS: Patients under 15 years old with a keratoconus diagnosis where analyzed. All of them answered a questionnaire, and were submitted to ocular examination and also computerized keratoscopy. These patients were divided into three groups and went through a contact lens test: 1) it was possible for this group to adapt to contact lenses; 2) a cornea transplant for this group was recommended; 3) for this group it was suggested that they use glasses. RESULTS: Patients who had 20/40 or greater visual acuity usually did not progress to transplant in the studied period. On the other hand, patients who had 20/60 or less acuity, progress to a deep transplant very quickly. Other cases, related to a lower age range (10-15 years old) progressed to a transplant. We can observe that the cornea apex has a very unsteady location, which explains the different difficulty levels regarding adaptation to contact lenses. In all patients who had a superior out of place apex and values greater than 66 D adaptation was successful. In the central apex eyes the adaptation was easier. In the inferior apex eyes it was not possible to set a standard to indicate the person for surgery. In the eyes which were adapted to the contact lenses and whose curvature was smaller than 51.10 D there were fewer chances of evolution to a cornea transplant, on comparison with patients who had a curvature of 57.60 or even greater. CONCLUSION: Patients who have curvatures greater than 57.40, acuity lower than 20/60 and are under 18 years old have more chances to evolve to a cornea transplant. When the keratocone apex is central the contact lens adaptation becomes easier.

Contact lens fitting in a patient with Alport syndrome and posterior polymorphous corneal dystrophy: a case report / Adaptação de lentes de contato em paciente com síndrome de Alport e distrofia polimorfa posterior: relato de caso

ABSTRACT Alport Syndrome is a hereditary disease that is caused by a gene mutation and affects the production of collagen in basement membranes; this condition causes hemorrhagic nephritis associated with deafness and ocular changes. The X-linked form of this disease is the most common and mainly affects males. Typical ocular findings are dot-and-fleck retinopathy, anterior lenticonus, and posterior polymorphous corneal dystrophy. Some cases involving polymorphous corneal dystrophy and corneal ectasia have been previously described. Here we present a case report of a 33-year-old female with Alport syndrome, posterior polymorphous corneal dystrophy, and irregular astigmatism, whose visual acuity improved with a rigid gas permeable contact lens.

RESUMO A síndrome de Alport é descrita como uma doença hereditária que afeta um gene relacionado à produção de colágeno das membranas basais causando nefrite hemorrágica associada com surdez e alterações oculares. A forma ligada ao X é a mais comum e afeta principalmente homens. Os achados oculares típicos são retinopatia em ponto-mancha, lenticone anterior e distrofia polimorfa posterior. Alguns casos foram descritos de associação entre a distrofia polimorfa posterior e ectasia corneana. Nós apresentamos um caso de paciente do sexo feminino, 33 anos, diagnóstico de síndrome de Alport, distrofia polimorfa posterior e astigmatismo irregular, que apresenta melhora da acuidade visual após adaptação com lentes de contato rígidas gás permeáveis.

Descriptive analysis of the type and design of contact lenses fitted according to keratoconus severity and morphology / Análise descritiva dos tipos e parâmetros das lentes de contato adaptadas de acordo com o grau evolutivo e a morfologia do ceratocone

ABSTRACT Purpose: Keratoconus is characterized by bilateral asymmetrical corneal ectasia that leads to inferior stromal thinning and corneal protrusion. There is currently a lack of consensus regarding the most efficacious method for fitting contact lenses in patients with keratoconus, given the various topographical patterns and evolution grades observed in affected populations. The purpose of the present study was to evaluate the association between keratoconus evolution grade and topography pattern and the type and design of fitted contact lens. Methods: We performed a retrospective analysis of contact lenses fitted in a total of 185 patients with keratoconus (325 eyes). Keratoconus was classified as either grade I, II, III, or IV based on keratometry and cone morphology (nipple, oval, globus, or indeterminate) results. Results: A total of 325 eyes were evaluated in the present study. Of the 62 eyes classified as grade I, 66.1% were fitted with monocurve contact lenses. Of the 162 eyes classified as grade I and II, 51%, 30%, and 19% were fitted with adapted monocurve rigid gas-permeable contact lenses (RGPCL), bicurve lenses, and others lens types, respectively. Bicurve lenses were fitted in 52.1% and 62.2% of eyes classified as grade III and IV, respectively. Of the eyes classified as grade III and IV, monocurve and bicurve RGPCL were fitted in 26% and 55%, respectively. In eyes with oval keratoconus, 45%, 35%, and 20% were fitted with monocurve lenses, bicurve lenses, and other lens types, respectively. In eyes with round cones (nipple morphology), 55%, 30%, and 15% were fitted with bicurve lenses, monocurve lenses, and other lens types, respectively. Conclusion: Monocurve RGPCL were most frequently fitted in patients with mild to moderate keratoconus and oval cones morphology, while bicurve lenses were more frequently fitted in patients with severe and advanced keratoconus. This was probably because bicurve lenses are more appropriate for round cones due to increased corneal asphericity.

RESUMO Objetivo: O ceratocone é uma ectasia corneana bilateral e assimétrica que leva a afinamento corneano inferior e protrusão da córnea, não existe consenso sobre qual é o melhor caminho para adaptar lentes de contato em pacientes com ceratocone, considerando seus diferentes padrões topográficos e graus de evolução. O objetivo desse estudo é associar o grau de evolução e padrão topográfico com o tipo/desenho da lente adaptada. Métodos: Análise retrospectiva das lentes de contato adaptadas em 185 pacientes com ceratocone (325 olhos) no Departamento de Lentes de Contato. O ceratocone foi classificado de acordo com a ceratometria em graus I, II, III e IV e de acordo com a morfologia em cone redondo, oval, globoso e indeterminado. Resultados: Foram avaliados 325 olhos. Em 66,1% dos olhos com grau I foi adaptada lente monocurva. Dos 162 olhos classificados como graus I e II foram adaptadas lentes monocurva em 51%, bicurva em 30% e outros em 19%. Em relação aos olhos grau III, em 52,1% foram adaptadas lentes bicurvas e o mesmo aconteceu em 62,2% dos olhos com grau IV. Apenas 26% dos olhos grau III ou IV receberam lentes monocurva, com necessidade de bicurvas em 55%. 45% dos cones ovais foram adaptados com lentes monocurva, 35% com bicurvas e 20% com outros tipos, enquanto 55% dos cones redondos foram adaptados com lentes bicurvas, apenas 30% com monocurvas e 15% com outros desenhos. Conclusão: Lentes de contato rígida gás-permeável (LCRGP) monocurvas são mais frequentemente utilizadas em ceratocones leves e moderados e em ovais, enquanto bicurvas são mais usadas para casos graves e avançados e em cones redondos.

A randomized clinical comparison of OPTI-FREE EXPRESS and ReNu MultiPLUS multipurpose lens care solutions.

OBJECTIVE: To evaluate subjective symptoms and clinical signs of tolerability and comfort in silicone and non-silicone hydrogel contact lens (CL) wearers using two different multipurpose solution (MPS) CL care regimens. METHODS: This was a randomized, double-masked, contralateral, crossover, multicenter (n=9) study. One hundred and eleven subjects were enrolled in the study, and were randomly assigned either silicone hydrogel CLs or non-silicone hydrogel CLs. Before wear, the CLs were randomly conditioned for at least 10 hours in a multipurpose disinfection solution (MPDS) preserved with either: Regimen 1-polyquaternium-1 0.001% and myristamidopropyl dimethylamine 0.0005% (POLYQUAD and ALDOX, respectively; OPTIFREE EXPRESS MPDS, Alcon Laboratories, Inc., Fort Worth, TX, USA); or Regimen 2-multipurpose solution preserved with polyhexamethylene biguanide 0.0001% (PHMB, ReNu MultiPLUS MPS, Bausch & Lomb, Rochester, NY, USA). The study had two in-office visits, 1 week apart. Subjects wore assigned CLs for approximately 4 hours at each visit. At each visit, subjects' eyes were examined before CL insertion and at 2 hours and 4 hours after insertion. Corneal staining type and area, conjunctival staining, conjunctival injection, subjective symptoms (tolerability), and comfort were evaluated. RESULTS: One hundred and five subjects (210 eyes) completed the study. The total corneal staining score of area and type were statistically significantly less in Regimen 1 than in Regimen 2 (P<0.000001). The area of conjunctival staining was statistically significantly less in Regimen 1 than in Regimen 2 (P=0.03). No clinically significant hyperemia was observed for either regimen. Both tolerability (P=0.02) and patient preference (P=0.05) were in favor of Regimen 1. CONCLUSIONS: Statistically significant clinical differences were evident between the two CL care regimens when used with silicone and non-silicone hydrogel CLs. OPTI-FREE EXPRESS MPDS users showed less corneal and conjunctival staining and reported greater comfort and tolerability to the CL/solution combination than ReNu MultiPLUS MPS users.