BCLA CLEAR – Medical use of contact lenses

Abstract

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

BCLA CLEAR - Evidence-based contact lens practice

“…Corneal topography can change with ocular pathology (such as keratoconus) (see CLEAR Medical Uses Report) [129] and affects lens fit more so for rigid corneal lenses (section 4.1). Central corneal radii over a 2− 3 mm radius can be quantified by conventional keratometry, which measures the separation of reflected pair(s) of mires [130].…”

“…Orthokeratology, scleral lenses and medical use of contact lenses have been covered in accompanying reports, so the following sections focus on soft and rigid corneal lenses (see CLEAR Orthokeratology Report and CLEAR Medical Uses Report) [93,129]. Direct evidence based on a patient's history, refractive error and ocular health that informs lens selection is summarised in Table 3.…”

“…Stevens-Johnson syndrome, or Sjøgren syndrome SOFT: ↑ Ocular comfort and ↑ VA with bandage lens vs autologous serum in Sjøgren syndrome [228] Consider SiHy overnight wear Unknown Consider ScCL in advanced stages [129,182,223] Post refractive surgery SOFT: ↑ Comfort, vision and ↓ symptoms with low modulus or newer lens designs [229] for corneal healing Advise DD or frequent replacement soft lenses…”

“…A reduction in visual quality between blinks could be due to dry eye (manage the dry eye disease and consider non-preserved lubricants [525]) or poor lens wettability (consider lens material and cleaning regimen). Optimal visual correction may require toric or presbyopic lens corrections (section 5.1.7) and rigid corneal lenses should be considered for irregular corneas (see CLEAR Medical Uses Report) [129].…”

Corneal Epithelial Stem Cells–Physiology, Pathophysiology and Therapeutic Options

“…Comparing the effect of autologous serum eye drops with different diluents, several studies have shown that higher concentrations (100%) of serum eye drops provide more benefits than lower concentrations in optimizing tear film stability and reducing symptoms [ 179 , 180 , 181 , 182 ]. Bandage contact lenses, including rigid gas permeable contact lenses, soft hydrogel contact lenses and silicone hydrogel contact lenses, can improve epithelial healing and eliminate chronic irritation in persistent epithelial defects [ 183 , 184 ]. Topical anti-inflammatory drugs, including non-steroidal anti-inflammatory drugs (NSAID) and ophthalmic steroids, play a role in suppressing the initial inflammatory response and in preventing LSCD [ 185 , 186 , 187 ].…”