Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities

Mandathara, Preeji S.; Stapleton, Fiona; Willcox, Mark

doi:10.1097/icl.0000000000000270

Cited by 32 publications

(23 citation statements)

References 177 publications

(185 reference statements)

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“…The approach includes the restoration of the normal visual acuity and/or correction of tectonic equilibrium of the corneal tissue. Rehabilitation of vision may be addressed from glasses in very early stages of the disease when regular astigmatism is present; the use of contact lens (CL) in more advanced cases or/and the application of different medical/surgical procedures when strengthening the cornea is also the target [ 10 ]. When extreme thinning or scarring is present, the condition warrants a corneal transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…Curiously, most of the studies published on KC management with CLs are case reports and prospective case series, retrospective and prospective comparative type with the absence of any randomized controlled trial [ 10 ]. A review of the published literature related to the visual outcomes and possible complications in the context of KC management using any of the previously described forms of CLs is the purpose of this article.…”

Section: Introductionmentioning

confidence: 99%

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Nonsurgical Procedures for Keratoconus Management

Rico-del-Viejo

García-Montero

Hernández-Verdejo

et al. 2017

Journal of Ophthalmology

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Objectives To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. Methods A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. Results The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. Conclusions In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonsurgical Procedures for Keratoconus Management

Rico-del-Viejo

García-Montero

Hernández-Verdejo

et al. 2017

Journal of Ophthalmology

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“…Several advanced design CL options are currently available to manage keratoconus of different disease severities (e.g. Kerasoft CL, Rose K2 CL and Scleral CL) but the relative performance of these CL in optimizing IQ in keratoconus remains unknown 31 . The purpose of this study was to use RGP CL's as a token measure of how optical intervention can alter the IQ in keratoconus, relative to unaided conditions and not to perform a comparative analysis of how IQ varies with disease severity or across different optical corrections.…”

Section: Discussionmentioning

confidence: 99%

A computational analysis of retinal image quality in eyes with keratoconus

Nilagiri

Metlapally

Schor

2020

Sci Rep

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Higher-order aberrations (HoA's) are exaggerated in eyes with keratoconus but little is known about their impact on the retinal image quality (IQ) of these eyes. This computational study determined changes in IQ [peak IQ, best focus and depth of focus (DOF)] of 12 subjects with manifest keratoconus in both eyes (KCE cohort), 9 subjects with very asymmetric ectasia (VAE cohort) with and without their Rigid Gas Permeable contact lenses (RGP CL's) and 20 age-matched controls, using a HOAbased through-focus analysis performed on the logNS IQ metric over 5 mm pupil diameter following cycloplegia. All IQ parameters were significantly worse in the KCE cohort with their native HOA's, relative to controls and in the ectatic eye of the VAE cohort, relative to the fellow non-ectatic eye (p ≤ 0.008 for all). Reduction in HOA's of these eyes with RGP CL's resulted in a significant improvement in all IQ parameters but they all remained significantly poorer than controls (p ≤ 0.02 for all). The intersubject variability of best focus and the DOF range were inversely related to peak IQ in these eyes (r = 0.85; p < 0.001). These results provide the optical basis for two clinical observations on keratoconus:(1) optical performance of keratoconic eyes are significantly better with RGP CL's than with spectacles or unaided conditions and (2) the endpoint of subjective refraction is elusive in keratoconic eyes, relative to healthy controls or to the non-ectatic eye in bilaterally asymmetric ectasia.Keratoconus is a progressive, non-inflammatory disease of one or both eyes characterized by thinning, anterior protrusion, increased asphericity and an eventual scarring and opacity of the cornea 1 . The disease may manifest itself with similar or dissimilar severity in the two eyes 1 . Optically, the disease is characterized by increased magnitude of sphero-cylindrical refractive errors and higher-order aberrations (HOA's) 2-5 . Many correction modalities including spectacles, soft toric, rigid gas permeable (RGP) and scleral CL's (CL) that reduce corneal asphericity are currently available for improving visual performance of these eyes 1 . Specifically, spatial and depth-vision (e.g. logMAR and stereoacuity) of keratoconic eyes has been shown to improve with RGP CL wear, relative to sphero-cylindrical spectacles 6-9 . This improvement is further enhanced by correcting these eyes with customized wavefront correcting CL's or lab-based adaptive optics apparatus 10-13 .Despite these advances, there is little information on the underlying changes in retinal image quality (IQ) of these eyes computed from objective wavefront measurements. A systematic analysis of IQ provides important insights into the performance of a keratoconic eye as an optical system, which determines the quality of information available for neural processing that ultimately governs visual performance. IQ significantly deteriorates in the presence of lower-and higher-order aberrations of the eye [14][15][16][17][18] . The loss of IQ in keratoconus with uncorrected lower-orde...

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“… 4 rigid gas permeable (RGP) contact lenses are the first option in the management of keratoconus patients to rehabilitate their vision and improve their quality of life. 5 In recent years, alternative options for fitting patients with advanced stages of keratoconus or patients who have failed with RGP contact lense design for keratoconus, such as hybrid or scleral contact lenses, have been proposed. 6 , 7 Application of all criteria may not be possible, so a compromise between these factors can help to gain relative satisfaction.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the visual acuity outcome between Clearkone and RGP lenses

Hassani

Jafarzadehpur

Mirzajani

et al. 2018

Journal of Current Ophthalmology

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PurposeTo compare the visual acuity outcome of the ClearKone SynergEyes™ hybrid contact lens and Boston XO rigid gas permeable (RGP) contact lens in patients with keratoconus.MethodsTwenty-eight eyes with keratoconus participated in this study. The visual acuity was examined once with the RGP lens and once with the ClearKone SynergEyes™ hybrid contact lens.ResultsThe mean corneal keratometry, the mean lens back optic zone radius, and the mean vault was 7.23 ± 0.62 mm, 7.67 ± 0.44 mm, and 277.94 ± 104.5 μm, respectively. Visual acuity was significantly better with the ClearKone SynergEyes™ hybrid lens (P = 0.004). The mean best corrected visual acuity (logMAR) was 0.022 ± 0.03 and 0.057 ± 0.09 for the ClearKone and RGP lens, respectively. The Clearkone lens yields an average improvement of one line of the Snellen chart in comparison with the RGP lens.ConclusionThe ClearKone hybrid contact lens and the RGP lens may improve visual acuity in corneal irregularities. But patients who are able to afford hybrid lens wearing may show better visual acuity.

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Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities

Cited by 32 publications

References 177 publications

Nonsurgical Procedures for Keratoconus Management

Nonsurgical Procedures for Keratoconus Management

A computational analysis of retinal image quality in eyes with keratoconus

A comparison of the visual acuity outcome between Clearkone and RGP lenses

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