Influence of Scleral Lens on Intraocular Pressure

Aitsebaomo, A. Philip; Wong-Powell, Jeannette; Miller, William L.; Amir, Farshid

doi:10.22374/jclrs.v3i1.34

Cited by 19 publications

(22 citation statements)

References 45 publications

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“…Studies have been conducted comparing IOP before and after scleral lens wear with mixed results. 7 , 8 However, pre-lens and post-lens measurement of IOP cannot definitively answer the fundamental question of what happens to IOP during lens wear. In addition to recognizing the possibility that IOP could normalize very shortly after lens removal, the process of applying or removing a lens from the ocular surface has been shown to cause a transient shift in IOP.…”

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confidence: 99%

Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear

et al. 2020

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SIGNIFICANCE As scleral lens wear becomes more common, understanding the impact of these lenses upon ocular physiology is critically important. Studies on the effect of scleral lens wear upon intraocular pressure (IOP) have used different instruments and have reported conflicting results. PURPOSE The purpose of this study was to compare assessment of IOP during scleral lens wear using pneumatonometry and transpalpebral tonometry. METHODS Twenty healthy subjects wore a small-diameter (15.2 mm) and a large-diameter (18.0 mm) scleral lens on the right eye, each for 1 hour in randomized order. IOP was assessed with pneumatonometry and transpalpebral tonometry on both eyes before lens application, immediately after lens application, after 1 hour of lens wear, and immediately after lens removal. Paired t test compared mean IOP in the study eye to the control eye. Repeated-measures ANOVA was performed to take instrumentation, lens diameter, and their interaction into account in an analysis of the change in IOP in the study eye. RESULTS Mean peripheral IOP measured with pneumatonometry was not significantly different from baseline at any subsequent measurement. Measurements with transpalpebral tonometry, however, were significantly different during scleral lens wear immediately after application and after 1 hour of wear with both diameter lenses ( P < .005), but were not significantly different after either sized lens was removed. Repeated-measures ANOVA revealed that the instrument used to measure IOP was a significant factor in IOP changes found during lens wear ( P ≤ .001). CONCLUSIONS Assessment of IOP during scleral lens wear varies based upon the instrument that is used. Although further studies are clearly needed to further elucidate this issue, clinicians should continue to monitor optic nerve structure and function in scleral lens wearers, as they do in all patients.

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Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear

et al. 2020

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“… 24–26 Differently, other authors found a rise in IOP (average of 5mmHg) following scleral lens removal (diameter between 14.6mm and 18mm) using GAT, DT, or Icare tonometer and during scleral CLs wear using DT or a rebound tonometer. 21 , 27–29 …”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] Differently, other authors found a rise in IOP (average of 5mmHg) following scleral lens removal (diameter between 14.6mm and 18mm) using GAT, DT, or Icare tonometer and during scleral CLs wear using DT or a rebound tonometer. 21,[27][28][29] Authors who found an IOP elevation consequently to scleral CL application supposed that such findings might be a consequence of increased susceptibility to scleral lensinduced IOP elevation due to having thinner scleral tissue. Indeed, a thinner sclera would be easier to applanate or indent by bearing areas of scleral lenses.…”

Section: Discussionmentioning

confidence: 99%

Effects of Scleral Contact Lenses for Keratoconus Management on Visual Quality and Intraocular Pressure

Formisano

Franzone

Alisi

et al. 2021

TCRM

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To evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. Methods: In a prospective case series a comparison was made between visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann Applanation Tonometer (GAT) before and after scleral CL wear. Results: The mean logMAR visual acuity improved from 0.2±0.25SD with glasses and 0.1 ±0.02SD with RGP, to −0.002±0.041SD when using the scleral CL (p<0.05). The mean IOP value before scleral CL wear was 12.93mmHg±2.20SD when measured with GAT and 7.85mmHg±2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg±2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ±2.40SD and the mean IOP measured with DT was 7.66mmHg±1.88SD. Therefore, during scleral CL wear, it was evidenced a small but statistically significant increase of the mean IOP value (1.01mmHg; p<0.01), with a reversion to values prior to application when scleral CL was removed. Conclusion: Scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. Even if it was evidenced a small increase of the mean IOP value during their wear, it may not be significant in otherwise healthy eyes. Statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap, that should be taken into account when there is a need to relate the DT values to the reference ones.

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“…Overall, studies thus far investigating a possible relationship between scleral lens wear and IOP have been equivocal. 10–12 Central to investigating any potential relationship, is a very basic question of what reliability are traditional tonometry options when applanated on the sclera, rather than the cornea, while a subject is wearing a PD or scleral lens. Of note, it is already widely agreed upon that scleral tonometry is significantly inaccurate when compared to corneal applanation tonometry.…”

Section: Discussionmentioning

confidence: 99%

Scleral Tonometry Precision During Scleral Lens Wear: A Pilot Study

Ganjei¹,

Shlager²,

Brocks³

2021

OPTO

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Purpose To evaluate the reproducibility, and therefore the utility, of using traditional tonometry devices for measuring intraocular pressure (IOP), while a prosthetic replacement of the ocular surface ecosystem device (PD) or scleral lens is applied to the eye. Patients and Methods Twenty subjects (40 eyes) with keratoconus were enrolled. With PD applied, the first 10 consecutive patients had IOP measured multiple times with a handheld tonometer (Tono-Pen AVIA, Reichert, Depew, NY) on the superotemporal sclera 1 mm posterior to the PD edge. This identical procedure was repeated for the next 10 consecutive patients with a pneumatonometer (Model 30, Reichert, Depew, NY). Once three reliable measurements, as defined by the study protocol, were obtained for an eye, the procedure was repeated with the same tonometer device on the fellow eye. Results The mean standard deviation for reliable IOP measurements was ±2.92 mmHg, median (IQR) of 2.62 (1.68 to 3.53) mmHg in the handheld tonometer group and ±1.98 mmHg in the pneumatonometer group. There was no statistically significant difference between the groups (p = 0.07). The mean IOP range for the reliable IOP measurements was 5.5 ± 3.80 mmHg, median (IQR) of 5 (3 to 7) mmHg for the handheld tonometer group and 3.71 ±1.12 mmHg in the pneumatonometer group. There was no statistically significant difference between the groups (p = 0.06). Conclusion Handheld tonometry and pneumatonometry have poor reproducibility when used to measure scleral IOP in keratoconus patients, while a PD is applied to the eye. An alternative research model and methodology should be investigated and confirmed to have precision prior to proceeding with further analysis of any relationship between scleral lens wear and IOP.

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Influence of Scleral Lens on Intraocular Pressure

Cited by 19 publications

References 45 publications

Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear

Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear

Effects of Scleral Contact Lenses for Keratoconus Management on Visual Quality and Intraocular Pressure

Scleral Tonometry Precision During Scleral Lens Wear: A Pilot Study

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