Contact lens impact on quality of life in keratoconus patients: rigid gas permeable versus soft siliconehydrogel keratoconus lenses

AIMTo determine the impact of rigid gas permeable (RGP) and silicone-hydrogel keratoconus lenses on the quality of life (QoL) in keratoconus (KCN) patients using the self-reported results from the Contact Lens Impact on Quality of Life (CLIQ) Questionnaire.METHODSFrom January 2013 to April 2013, 27 consecutive KCN patients who wore RGP contact lenses (conflexair100 UV KE Zeiss-Wöhlk) or soft silicone-hydrogel contact lenses (SHCLs) for KCN (KeraSoft IC- Bausch&Lomb or Hydrocone Toris K-Swiss lens) completed the CLIQ questionnaire.RESULTSThe mean age of 27 patients was 29.6±8.0y. Fifteen patients were RGP user. The groups were comparable with respect to the mean patient age, sex, and mean K values (P=0.1, P=0.8 and P=0.1, respectively). The mean CLIQperson measure was 42.8±5.5 in RGP group and 39.6±5.5 in SHCLs for KCN group (P=0.06). CLIQperson measure was positively correlated with steep K value (r=0.301, P=0.04). When eyes were stratified by visual acuity with contact lenses, the mean CLIQperson measure was 42.01±5.6 in eyes with a visual acuity of 20/20-20/25 (n=44) and 38.4±5.26 in eyes with a visual acuity of 20/32 or less (n=10; P=0.097).CONCLUSIONRGP lenses and SHCLs for KCN have similar impact on QoL.

Aberration changes of the corneal anterior surface following discontinued use of rigid gas permeable contact lenses

AIM: To record aberrations with a corneal topographic device on the anterior surface of the cornea at different time-points prior to wearing and following discontinued use of rigid gas permeable (RGP) contact lenses. The effect of wearing RGP on the anterior surface of the cornea was discussed to provide guidance for clinical refractive error correction.METHODS: The study objects were 24 eyes from 24 patients. All patients underwent identical examination procedures prior to lens use, as well as afterwards, including slit-lamp examination, non-contact tonometer measurement, computer optometry and corneal curvature measurement, subjective refraction test, and corneal topography analysis. The patients wore contact lenses everyday for 1 month and then discontinued. Corneal topographies were recorded at certain time points of 30 minutes, 1 day, 3, 7 and 14 days following use.RESULTS: Total corneal aberration at each time point following discontinued use of RGP contact lenses was less than the time point prior to use. Detailed results were as follows: root mean square (RMS) (pre)=(1.438± 0.328)μm, RMS (30 minutes) =(1.076 ±0.355)μm, RMS (1 day) =(1.362 ±0.402)μm, RMS (3 days) =(1.373 ±0.398)μm, RMS (7 days) =(1.387 ±0.415)μm, and RMS (14 days) = (1.430±0.423)μm. Results showed that at 30 minutes after discontinued use of RGP contact lenses, almost all 2 ndand 3 rd-order aberrations change. Quadrafoil Z10 and spherical Z12 of the 4 th-order were also changed. Alterations to Z5, Z6, and Z12 at 1 day after discontinued use were significant differences compared with the time period prior to RGP use: Z5 and Z6 decreased, and Z12 increased slightly. Z5 and Z6 remained decreased at 3 days after discontinued use, but Z9 and Z10 continued to increase and Z12 returned to levels prior to RGP use. At 14 days after discontinued use, all aberrations were notsignificantly different from the values prior to use.CONCLUSION: The use RGP contact lenses greatly reduced total aberration of the anterior surface of the cornea. Changes to 2 ndand 3 rd-order aberrations (including Z3, Z4, Z5, Z6, Z7, and Z8) were more significant. Following discontinued use of RGP contact lenses, the majority of lower order aberrations returned to original levels in a short period of time. During this process, a transient higher order aberration appeared, but all changes disappeared within 14 days after discontinued use of RGP contact lenses.

Effect of rigid gas permeable contact lens on keratoconus progression: a review

The prevalence of keratoconus is 1/2000 in the general population and is high in adolescents.Keratoconus is a progressive disease,which has a great impact on patients’quality of life and mental health.It can be managed by surgical and non-surgical means,rigid gas permeable(RGP)contact lens as its main non-surgical method is widely used in clinic.The efficacy of wearing RGP contact lens has been confirmed to some extent,but some studies have found that wearing RGP contact lens has adverse effects,which may promote disease progression.In this paper,the advantages and disadvantages of RGP contact lens in controlling keratoconus were reviewed to provide more suggestions and references for the clinical application of RGP contact lens.

Effects of rigid gas permeable contact lens on morphological parameters and vision-related quality of life in keratoconus patients

AIM: To evaluate the effect of rigid gas permeable contact lens(RGP-CL) on corneal morphological parameters and vision-related quality of life in keratoconus(KC) patients.METHODS: Totally 57 eyes of 30 KC patients who were followed-up for more than two years, including 17 RGP wearers(32 eyes) and 13 non-wearers(25 eyes) were retrospectively analyzed. Initial medical history and corneal topography were collected at baseline. Corneal topography, corneal aberration, optical coherence tomography, and vision-related quality of life questionnaires were performed at the last follow-up.RESULTS: According to corneal topography, increase of the flattest keratometric values was higher in RGP wearers than in non-wearers(P=0.038). The morphological parameters, including symmetry index of front corneal curvature(P=0.004) and Baiocchi-Calossi-Versaci index front(P=0.047), were lower in RGP wearers than in nonwearers. Vertical coma was smaller in RGP wearers than non-wearers in 3.0, 5.0, 6.0, and 7.0 mm pupil diameters, respectively(P<0.05). The environmental triggering domain of ocular surface disease index was worse in RGP wearers as compared to non-wearers(P=0.003). At the last followup, there were no significant differences in constituent ratios of KC progression, corneal thickness topography, epithelial thickness topography, morphological parameters of corneal topography, and other questionnaire scores between the two groups(all P>0.05).CONCLUSION: Long-term use of RGP does not worsen KC but may cause corneal epithelial remodeling to increase symmetry of corneal anterior surface, reduce corneal vertical coma and improve visual quality. However, RGP wearing causes a slight decrease in vision-related quality of life. The occurrence of ocular surface symptoms is mainly associated with environmental triggering factors.

Profile and Performance of Rigid Gas Permeable and Scleral Lenses on Keratoconic Patients in the Developing Contact Lens Practice Settings

Purpose: To present the profile of keratoconic contact lens wearers, alongside with performance of corneal and scleral rigid gas permeable (RGP) at different stages of keratoconus based on limited diagnostic resources. Methods: 5-year Clinical records of keratoconic corneal and scleral RGP contact lens wearers were retrieved. Data on age, gender, visual acuity (VA), refraction (RE), stage of keratoconus and mode of correction among other variables were obtained for analysis. Information pertaining to the outcome in pre and post-fit at different severity was determined. Results: A total of 124 medical records were analyzed, with the age (20.86 ± 9.50 years), gender (58.9% male and 41.1% female), Laterality (57.3% bilateral, 26.6% right eye and left eye as 16.1%) and ethnicity (91.1% Africans and 8.9% Asians). There were no significant differences in effects of lenses (RGP and Scleral lenses) across three stages in visual acuity and in three stages of severity HRGP (2) = 1.05, p = 0.59; HScleral (1) = 2.24, p = 0.134. Similar non-significant effect was observed in refractive error correction HRGP (2) = 1.62, p = 0.44: HScleral (1) = 1.143, p = 0.285. Conclusion: The profile of KC contact lens wearer was comparable to other studies in developing setting. Keratoconic grading should be based on available resources. Corneal rigid gas permeable and scleral lenses were beneficial to keratoconic patients in respect of refractive error correction and visual improvement to keratoconic patient.

RGP治疗成人高度屈光不正性弱视的疗效

目的:探讨硬性透氧性角膜接触镜(rigid gas-permeable contact lenses,RGP)治疗成人高度屈光不正性弱视的疗效。方法:对26例49眼成人高度屈光不正性弱视患者行RGP验配。随访观察6mo,回顾性分析其疗效。结果:患者戴镜前屈光度球镜-14.90±4.95D,散光-2.59±1.60D,框架眼镜最佳矫正视力平均4.64±0.16。首次配戴RGP后最佳矫正视力为4.79±0.17,经配对t检验,差异具有显著统计学意义(t=-8.999,P<0.01);配戴1,3,6mo后,矫正视力保持稳定,未见下降,视觉质量满意。镜片配适良好,未见角结膜严重并发症。结论:RGP为成人高度屈光不正性弱视提供了优质的视觉矫正效果,可进一步推广。

50例配戴硬性透气性角膜接触镜患者的临床观察

目的评价硬性透气性角膜接触镜的临床矫正效果以及安全性。方法对配戴硬性透气性角膜接触镜后的高度近视≥—6.00 DS 25例(50只眼)、散光≥—2.50 DS 20例(40只眼),进行1周及1、3、6个月的视力观察;对圆锥角膜患者5人(10只眼)行3、6、12个月的视力及角膜曲率的观察。结果硬性透气性角膜接触镜能有效的矫正屈光不正,且使圆锥角膜得到有效控制。结论硬性透气性角膜接触镜矫正屈光不正和圆锥角膜安全有效,且优于框架眼镜。

配戴透气性硬性角膜接触镜后结膜表面细胞变化

目的研究透气性硬性角膜接触镜对结膜表面细胞的影响。方法选取验配透气性硬性角膜接触镜的屈光不正患者30例60眼,根据屈光度、角膜曲率和配适情况,选择适合的镜片。于戴镜前及戴镜后6个月、1a分别进行结膜印迹细胞学检查,显微镜下观察结膜上皮细胞、杯状细胞,并对其进行分级,计数100倍条件下,7.20mm×5.35mm范围内上皮细胞和杯状细胞。结果配戴透气性硬性角膜接触镜前下睑结膜上皮细胞(318.5±155.4)个,下睑结膜杯状细胞(13.6±6.8)个,球结膜上皮细胞(244.1±110.9)个,杯状细胞(15.2±5.7)个;6个月后下睑结膜上皮细胞(305.6±79.9)个,杯状细胞(13.2±6.6)个,球结膜上皮细胞(226.7±86.3)个,球结膜杯状细胞(15.1±5.5)个;1a后下睑结膜上皮细胞(272.9±86.4)个,下睑结膜杯状细胞(12.3±5.9)个,球结膜上皮细胞(228.5±155.4)个,球结膜杯状细胞(14.3±6.6)个。戴镜后6个月、1a,下睑结膜及球结膜上皮细胞、杯状细胞密度与配戴前相比,差异均无统计学意义(均为P>0.05);戴镜后1a,CIC分级与戴镜前相比,差异无统计学意义(P>0.05)。结论配戴透气性硬性角膜接触镜对下睑结膜及球结膜影响较小。

RGPCL矫治圆锥角膜长期临床观察

目的观察RGPCL矫治圆锥角膜的长期临床应用效果。方法回顾性研究。以2005—2009年间在沈阳爱尔眼科医院视光中心因圆锥角膜验配RGPCL患者为研究对象，共260例（496眼）。男212例，女48例。所有患者随访观察时间至少4年。评估RGPCL镜片配适状态，对配戴框架眼镜和RGPCL的矫正视力．配戴RGPCL前后圆锥锥顶K值及角膜厚度进行比较，观察角膜曲率的变化及并发症的发生情况。数据采用配对t检验进行分析。结果所有病例配戴RGPCL初期获得满意的矫正视力，框架眼镜矫正视力与RGPCL比较差异有统计学意义（t=-25．55，P〈0．05）。4年后，框架眼镜矫正视力与RGPCL矫正视力差异有统计学意义（t=-30．02，P〈0．05）。配戴RGPCL前及4年后圆锥锥顶K值比较差异有统计学意义（t=3．02，P〈0．05），圆锥锥顶厚度比较差异无统计学意义（t=1．46，t9〉0．05）。432眼（87．1％）的配适状态为三点接触，46眼（9．3％）为顶点充盈，18眼（3．6％）为可接受的顶点接触。角膜醢率变化情况为，仅3眼（0.6％）陡峭角膜曲率值增加，64眼（12.9％）扁平角膜曲率值增加。随访期间，所有病例均未弃戴，33眼（6.6％）出现角膜上皮点状着染，未发现角膜缘新生血管，无角膜溃疡等严重并发症。结论圆锥角膜患者配戴RGPCL能获得满意的矫正视力。能延缓圆锥角膜发展，且无严重并发症发生。

RGPCL矫正角膜手术后圆锥角膜和不规则散光的疗效观察

目的观察RGPCL矫正角膜手术后圆锥角膜和不规则散光的临床疗效和安全性。方法回顾性病例研究。选择因角膜手术后继发圆锥角膜和不规则散光而验配RGPCL的患者29例（38眼），其中LASIK术后继发圆锥角膜12例（14眼）、LASEK术后继发圆锥角膜1例（1眼）、角膜移植术后不规则散光8例（13眼）、放射状角膜切开术后不规则散光2例（4眼）、LASIK术后不规则散光6例（6眼）。在裂隙灯下进行RGPCL试戴荧光素染色评估后确定处方。采用配对t检验对框架眼镜和RGPCL的矫正视力进行比较。患者填写主观自评表评价配戴RGPCL的舒适度和取戴、清洗镜片的难易度。结果配戴框架眼镜最佳矫正视力≤44.2、4.3-4.4、4.5—4.6、4.7—4.8、4.9～5.0、〉5.0分别为5眼（13％）、5眼（13％）、8眼（21％）、10眼（26％）、10眼（26％）、0眼（0％）。戴RGPCL后拥有相应程度最佳矫正视力的眼数分别为O眼（0％）、0眼（0％）、0眼（0％）、3眼（8％）、15眼（39％）、20眼（53％）。配戴RGPCL最佳矫正视力好于框架眼镜（t=-4.416，P〈0.01）。配戴者觉得舒适及取戴、清洁容易的分别为48％、69％、59％。随访期间未发现明显眼部并发症。结论RGPCL矫正角膜手术后继发圆锥角膜和不规则散光的视觉效果优于框架眼镜，且无明显的并发症发生。

硬性透氧性角膜接触镜矫正特殊类型屈光不正的效果观察

目的 观察硬性透氧性角膜接触镜（rigidgas permeable contactlens,RGPCL）矫正特殊类型屈光不正的临床疗效及安全性.方法 收集验配RGPCL的患者61例（98只眼）,包括高度近视29例（55只眼）、高度散光9例（18只眼）、无晶状体高度远视20例（20只眼）、屈光参差3例（5只眼）.在裂隙灯下进行荧光素染色配戴评估后确定处方,定期复查随访6～12个月.结果 98眼均一次配适成功.高度近视组佩戴框架眼镜和RGPCL后矫正视力≥4.9分别为37眼（67.27%）、47只眼（85.46%）,平均最佳矫正视力RGPCL好于框架眼镜（P〈0.05）;无晶状体眼高度远视组佩戴框架眼镜和RGPCL后矫正视力≥4.9分别为7眼（38.9%）、6只眼（33.3%）,平均最佳矫正视力两者间无差异（P〉0.05）;高度散光组佩戴框架眼镜和RGPCL后矫正视力≥4.9分别为15只眼（75%）、20只眼（100%）,平均最佳矫正视力RGPCL好于框架眼镜（P〈0.05）;屈光参差者佩戴RGP后达到双眼平衡.随访未发现明显眼部并发症.结论 对于特殊类型屈光不正,RGPCL的视觉效果明显优于框架眼镜,并有较高地安全性,无明显并发症发生.

RGPCL对圆锥角膜前表面形态的影响

目的 观察RGPCL对圆锥角膜患者的视力及角膜前表面形态的影响.方法 回顾性病例对照研究.Pentacam眼前节分析系统分期为KK2期的圆锥角膜眼,有效配戴RGPCL者22例（28眼）作为实验组,无效配戴RGPCL者8例（9眼）作为对照组,均为理想或可接受的三点接触的配适状态.观察配戴RGPCL 1年后的矫正视力及配戴前后角膜前表面形态学参数的变化.采用配对t检验进行数据分析.结果 配戴RGPCL 1年后患者矫正视力提高,明显优于框架眼镜.与对照组相比,角膜前表面曲率平坦K值变化不大（P＞0.05）,而陡峭K值明显变小（t=4.420,P＜0.01）,角膜散光变小（t=4.271,P＜0.01）,形态学参数中表面变异指数（ISV）、高度不对称性指数（IHA）变小（t=2.939,P＜0.01;t=1.690,P＜0.05）,最小曲率半径（Rmin）变大（t=2.315,P＜0.05）,圆锥角膜指数（KI）、中央圆锥角膜指数（CKI）、IVA、高度离心指数（IHD）差异无统计学意义（P＞0.05）.所有患眼随诊期都无严重并发症出现.结论 配戴RGPCL对KK2期圆锥角膜眼不但可提高视力而且能改善病变区角膜形态,是目前非手术方法矫治圆锥角膜的安全有效方法。

透气性硬性角膜接触镜矫正亚临床型圆锥角膜的临床观察

目的观察透气性硬性角膜接触镜（RGPCL）矫正亚临床型圆锥角膜的效果以及长期配戴后角膜地形图的改变。方法对22例一眼经Orbscan Ⅱ眼前节系统检查已确诊为圆锥角膜；另一眼角膜地形同够示角膜厚度≤500μm或后表面Diff值≥0．05mm的亚临床型阋锥角膜，根据屈光度、角膜曲率和配适情况，选择适合的镜片。于戴镜后每年行Orbscan Ⅱ检查，随访两年。观察角膜前表面曲率、角膜前表面及后表面Diff值、I-S值、角膜后表面屈光度、角膜厚度、前房深度的变化。结果总体平均近视度和散光度分别为（-5．13±2．61）D和（-1．15±0．81）D。框架眼镜矫正视力≥1．0者为16例，占总数的72．7％；戴刚RGPCL后矫正视力≥1．0者为100％。配戴RGPCI。的矫正效果明显优于框架，视力差异具有统计学意义（P〈0．05）。角膜地形图各项值统计结果冠示．角膜前表面曲率半径平均值大于配戴前，I—S值降低，差异具有统计学意义（P〈0．05）。角膜前表面及后表面Diff值、角膜后表面屈光度、角膜厚度、前房深度前后变化无统计学意义（P〉0．05）。结论RGPCI。的合适配戴能在一定程度上控制亚临床型圆锥角膜的进展。

硬性透气性角膜接触镜矫治成人高度及超高度屈光不正性弱视

目的:观察硬性透气性角膜接触镜(RGP)矫治成人高度及超高度屈光不正性弱视的效果和影响因素。方法:对26例(49眼)的成人高度屈光不正及超高度屈光不正弱视患者行RGP配戴。分析屈光度、角膜地形图、角膜曲率等配戴前检查。观察配适、视力矫正效果和并发症。结果:患者屈光度等效球镜值范围为-6.00D^-24.25D,框架眼镜最佳矫正视力平均为4.64±0.16,≥4.9者4眼,占8.16%。配戴RGP后最佳矫正视力平均为4.79±0.17,≥4.9者21眼,占42.86%。差异具有显著统计学意义(χ2=15.519,P<0.001)。其中有9眼(18.37%)戴RGP前被诊断为弱视的患者,戴RGP后矫正视力≥5.0。配戴1月,3月,6月后的矫正视力保持稳定,未见下降。患者操作熟练,适应感良好,视觉质量提高明显。镜片配适中心定位好,活动度良好,未见角结膜严重并发症。结论:RGP矫治成人高度及超高度屈光不正性弱视安全有效,值得推广。

硬性角膜接触镜对圆锥角膜矫治作用

目的观察硬性透气性角膜接触镜（rigid gas permeable contact lens，RGPCL）对圆锥角膜患者的屈光矫正作用。方法临床病例系列研究。收集2010年1月至2012年12月在天津市眼科医院就诊的圆锥角膜患者40例（72只眼），根据最大拟似角膜计值（SimKmax）将患者分为两组：SimKmax《47 D为轻度组，共24例（43只眼）；SimKmax》47 D为中重度组，共16例（29只眼）。分别观察两组患者配戴RGPCL前后的最佳矫正视力、角膜地形图变化和眼部病变进展情况。结果在40例（72只眼）中，38例（70只眼）圆锥角膜患者完成12个月随访，并通过配戴RGPCL后均获得较好的矫正视力（0.6-1.0），角膜病变进展得到一定缓解，未发现有眼部明显并发症。另2例（2只眼）中，有1例轻度组患者（1只眼）因配戴后无法适应而放弃使用；余1例中重度组患者（1只眼）因病情加重和矫正视力下降，在戴镜3个月后行穿透性角膜移植手术。结论科学合理地长期配戴RGPCL，可使圆锥角膜患者获得较好地矫正视力．延缓病情进展或推迟角膜手术时间。

圆锥角膜患者配戴RGPCL前后视觉相关生活质量的比较

目的：探讨配戴硬性透气性角膜接触镜（RGPCL）对原发性和继发性圆锥角膜患者生活质量的影响。方法：前瞻性研究。选取温州医科大学附属眼视光医院门诊部2014 年7月至2016 年10 月间验配RGPCL的患者，在验配前测得患者配戴框架眼镜的单眼最佳矫正视力，采用生活质量量表（VF-QOL）问卷自我打分，在配戴RGPCL 1个月后复查患者的戴镜视力，并且再次使用VF-QOL问卷自我打分。数据采用中位数（最小值～最大值）表示，配戴RGPCL前后各数据比较使用Wilcoxon秩和检验。结果：最终收集圆锥角患者70例（137眼），配戴RGPCL前双眼中视力较好眼的视力为4.8（4.0～5.0），配戴后为5.0（4.8～5.1）。配戴RGPCL前双眼中视力较差眼的视力为4.5（4.0～4.9），配戴后为4.9（4.0～5.1）；配戴RGPCL前后较好眼、较差眼视力比较差异均有统计学意义（Z=5.92、6.28，P 〈 0.001）。配戴RGPCL前视功能维度分值为27（ 12～48），配戴后为19（ 12～30），配戴前后差异具有统计学意义（Z=6.64，P 〈 0.001）。配戴RGPCL前自理、活动、社交、心理4个方面的分值中位数分别为4、4、4、5，配戴后分别为4、3、2、4，配戴前后比较差异均有统计学意义（Z=3.74、5.18、5.20、4.98，P 〈 0.001）。结论：VF-QOL问卷分析表明配戴RGPCL可以提高圆锥角膜患者的视功能同时也提升了患者的生活质量。