Lose the Nintendo and thou shall be healed! Restoring vision in malingering.

Non-organic visual loss can be hard to prove or explain to the parents of affected children at times. Here, we describe a simple yet effective approach that may help solve both issues by ensuring that the patient refrains from visual stimuli.

Clinical Outcome of Hybrid Contact Lenses in Keratoconus.

OBJECTIVES: To report the clinical outcome of hybrid contact lens fitting in keratoconus. METHODS: A retrospective chart review was performed of keratoconus patients who had been fitted with hybrid contact lenses in one or both eyes. Patients with a history of previous intraocular surgery (except for corneal crosslinking) and relevant concurrent ocular disease limiting visual outcome were excluded. The outcome data at 6-month follow-up included hybrid lens-corrected visual acuity, wearing time, and lens discontinuation. RESULTS: Fifty-four keratoconus patients (102 eyes) were included. Mean visual acuity with habitual correction before hybrid lens fitting was 0.63±0.29 (decimal Snellen). Eyes were fitted with Eyebrid lenses (LCS Laboratories, Caen, France) and SynergEyes lenses (SynergEyes Inc., Carlsbad, CA). Refits were necessary in 13 eyes, because of poor fitting (76.9%) or suboptimal refraction (23.1%). Visual acuity had significantly improved with hybrid lenses (0.93±0.14; P<0.0001). In 37 eyes (37.8%), hybrid lens wear was discontinued within 6 months after lens fitting. Reported issues were discomfort in 27 eyes (73%), handling difficulties in 14 eyes (37.8%) and poor vision in 1 eye (2.7%). Success rate of lens fitting was significantly correlated to cone morphology (P=0.01). CONCLUSIONS: New generation hybrid lenses are an appropriate, safe therapeutic option for keratoconus patients. Excellent visual outcomes are achieved in successful fittings, yet a dropout rate of 37.8%-mainly occurring in sagging, more peripheral, cones - still limit their clinical success.