Factors associated with patient-reported midday fogging in established scleral lens wearers

Schornack, Muriel; Fogt, Jennifer Swingle; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Cao, Dingcai; Shorter, Ellen

doi:10.1016/j.clae.2020.03.005

Cited by 26 publications

(30 citation statements)

References 22 publications

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“… 2 , 30 This may be due to the lack of inclusion of first-year data in the study. Schornack et al 11 did not find an association between midday fogging and either lens design or care products and reported a frequency of 25% (n = 248). Our study found a higher rate of adverse events related to scleral lens material properties, consistent with the findings by Tan et al 32 that gas-permeable lenses are more prone to deposit than PMMA lens materials.…”

Section: Discussionmentioning

confidence: 92%

“…Physiological adverse events surveyed included corneal hydrops, pingueculitis, corneal inflammatory events (symptomatic and asymptomatic), 38 – 42 contact lens–associated red eye, corneal abrasion, phlyctenulosis, and microbial keratitis. Lens-related adverse events included the presence of lens deposits, 26 lens intolerance, 43 , 44 tear reservoir clouding, 11 , 45 – 47 difficulty handling the lenses, 45 , 48 and poor lens wettability. 26 Specific details of the complications and their management strategies were documented.…”

Section: Methodsmentioning

confidence: 99%

“… 1 It was estimated that in 2016, 70,000 individuals in the United States wore a scleral lens. 2 Modern scleral lens indications include corneal ectasia (27.5 to 91%), 3 – 10 post-surgical or post-traumatic corneal irregularity (17.6 to 40.0%), 3 – 6 , 8 – 10 ocular surface diseases (3 to 49%), 3 – 5 , 7 – 11 aphakia (2 to 23%), 3 , 7 – 9 refractive errors (2.6 to 10%), 3 , 8 , 10 , 11 and others. 1 , 12 Keratoconus is the primary indication for scleral lens wear.…”

mentioning

confidence: 99%

“… 7 , 23 – 25 Common physiological complications include hypoxia leading to corneal edema (7.4%), 3 neovascularization (1.1 to 13.3%), 3 , 26 corneal abrasion (3.1%), 3 and infection, inflammation, and solution toxicity. 2 , 3 , 7 , 23 – 25 , 27 – 29 Other lens-related adverse events are midday fogging (20 to 46%; McKinney et al IOVS 2013;54:ARVO E-Abstract 5483), 2 , 11 mechanical irritation (12.6%), 3 protein deposits (3.5%), 3 giant papillary conjunctivitis (1.7%), 3 and poor lens fit due to disease progression. 2 , 3 , 7 , 23 – 25 , 27 – 29 A survey of 164 scleral lens practitioners revealed that common minor complications include poor lens wetting (90.8%), lens fogging (84.8%), blurred vision (53%), ocular redness (34.8%), ocular dryness (24.4%), and ocular pain/discomfort (20.7%).…”

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confidence: 99%

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Safety and Efficacy of Scleral Lenses for Keratoconus

Fuller

Wang

2020

Optom Vis Sci

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SIGNIFICANCE This study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus. PURPOSE This study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population. METHODS A retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for ≥1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma. RESULTS A total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 ± 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 ± 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens–induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses ( P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression. CONCLUSIONS Consistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Safety and Efficacy of Scleral Lenses for Keratoconus

Fuller

Wang

2020

Optom Vis Sci

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“…2 Studies have reported that 26% to 46% of scleral lens wearers experience midday fogging. [3][4][5] Biomicroscopy evaluation of the debris reveals variation in the color and in the appearance of particulate among patients, with sizes of the particulate varying from fine particulate to larger droplets or coalesced, globules. 6 A patient with midday fogging may have one or more of these types of particulate present in the post-lens reservoir, and the variation in the appearance of fogging particulate is likely a result of multiple causes for this condition.…”

Section: Introductionmentioning

confidence: 99%

Midday Fogging of Scleral Contact Lenses: Current Perspectives

Fogt¹

2021

OPTO

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Midday fogging is a common problem in scleral lens wear, as particles accumulate in the tear reservoir between the posterior surface of the lens and the front of the ocular surface during wear. As particulate waste collects, symptoms of blurred vision and discomfort arise, typically leading patients to remove their lenses for cleaning, refilling with fresh solution, and reinsertion into the eye. The appearance of the particulate can vary, likely due to different causes for midday fogging. Studies which attempted to identify the particulate have given some insight into some of the causes, but larger studies are needed to identify this debris. Research on lens solutions used for filling the lens reservoir and of various aspects of scleral lens fits have also begun to culminate in the concept that midday fogging may ultimately be related to inflammation. Since scleral lens wearers can have varied and multiple sources of inflammation, strategies in minimizing midday fogging can differ between patients.

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Rigid Scleral and Corneoscleral Lens Design and Fitting

Vincent¹

2024

Contact Lens Practice

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Factors associated with patient-reported midday fogging in established scleral lens wearers

Cited by 26 publications

References 22 publications

Safety and Efficacy of Scleral Lenses for Keratoconus

Safety and Efficacy of Scleral Lenses for Keratoconus

Midday Fogging of Scleral Contact Lenses: Current Perspectives

Rigid Scleral and Corneoscleral Lens Design and Fitting

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