Wavefront-Guided Scleral Lens Prosthetic Device for Keratoconus

Sabesan, Ramkumar; Johns, Lynette; Tomashevskaya, Olga; Jacobs, Deborah S.; Rosenthal, Perry; Yoon, Geunyoung

doi:10.1097/opx.0b013e318288d19c

Cited by 84 publications

(95 citation statements)

References 33 publications

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“…While the gains in acuity compared to habitual correction are substantial, all 10 study eyes have poorer VA compared with age-matched normal levels, even though residual higher-order aberrations are within 1 SD of normal mean values. This is in agreement with prior reports by Sabesan et al 26 …”

Section: Resultssupporting

confidence: 94%

“…26 They also noted that while improved, visual performance did not reach levels seen in individuals that habitually experience normal levels of higher-order aberration.…”

mentioning

confidence: 99%

“…20 The literature currently contains several demonstrations of customized contact lenses that specifically target higher-order aberration. 21-26 For customized higher-order compensating optics to perform optimally, they must be integrated into a stable lens platform and properly aligned to the underlying optical errors. When a lens is not stable or is misaligned, aberration correction is reduced, and can actually lead to an increase in higher-order aberration and a reduction in visual performance.…”

mentioning

confidence: 99%

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Wavefront-Guided Scleral Lens Correction in Keratoconus

Marsack¹,

Ravikumar²,

Nguyen

et al. 2014

Optometry and Vision Science

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Purpose To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics; and to provide a detailed discussion of the process used to design, manufacture and evaluate wfgSCLs. Methods Fourteen eyes of 7 subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. Results The wfgSCL provided statistically lower levels of both lower-order RMS (p < 0.001) and higher-order RMS (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p < < 0.001). However, the wfgSCL does not provide less higher-order RMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual higher-order root mean square wavefront error (HORMS) less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to KC eyes. Conclusions Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease, and can provide visual image quality equivalent to that seen in normal eyes. Longer duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.

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Section: Resultssupporting

confidence: 94%

“…26 They also noted that while improved, visual performance did not reach levels seen in individuals that habitually experience normal levels of higher-order aberration.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Wavefront-Guided Scleral Lens Correction in Keratoconus

Marsack¹,

Ravikumar²,

Nguyen

et al. 2014

Optometry and Vision Science

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“…In particular, we outline the literature that has demonstrated the limitations associated with aberration-controlled soft contact lens designs and the need for further work to validate the clinical feasibility of such modalities for the management of keratoconus. Although still currently limited to the research domain and not yet directly applicable to managing patients in clinical practice, we agree with the sentiment that customised aberration-controlled scleral lenses 2,3 show promise as a potential future vision-correction platform for keratoconus. In a small population of seven individuals with keratoconus, Marsack and colleagues 2 have shown that wave-front guided scleral contact lenses can optically compensate for higher-order aberrations; however, as these authors note, 2 a range of factors will need to be surmounted in order for the custom correction of highly aberrated eyes to achieve clinical translation.…”

Section: Editorsupporting

confidence: 56%

Response to Re: Contact lens management of keratoconus

Downie

Lindsay²

2016

Clinical and Experimental Optometry

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EDITOR:We thank Dr Jinabhai for his letter, which describes some of the challenges associated with correcting high-order aberrations in keratoconus.In our recent Invited Review, 1 we provide a comprehensive review of contemporary contact lens modalities for the optical correction of keratoconus in clinical practice. As outlined in the text, our manuscript intends to provide a clinically practicable overview of the relevant contact lens options that are currently vailable to clinicians, including soft, hybrid, rigid, piggyback, corneo-scleral, miniscleral and scleral lenses. Given the strong clinical focus of the review, we also provide an in-depth consideration of relevant pragmatic considerations associated with fitting these designs to patients with keratoconus.In our paper, we discuss the need for further research in a range of areas relevant to contact lens fitting for keratoconus. In particular, we outline the literature that has demonstrated the limitations associated with aberration-controlled soft contact lens designs and the need for further work to validate the clinical feasibility of such modalities for the management of keratoconus. Although still currently limited to the research domain and not yet directly applicable to managing patients in clinical practice, we agree with the sentiment that customised aberration-controlled scleral lenses 2,3 show promise as a potential future vision-correction platform for keratoconus. In a small population of seven individuals with keratoconus, Marsack and colleagues 2 have shown that wave-front guided scleral contact lenses can optically compensate for higher-order aberrations; however, as these authors note, 2 a range of factors will need to be surmounted in order for the custom correction of highly aberrated eyes to achieve clinical translation. Such factors include the complexity of fitting (and the need for highly repeatable centration), the current cost of the devices (to patient and practitioner) and longer-duration studies to assess real-world effects on visual performance.We are excited by the potential for novel and emerging contact lens technologies to become available for the optical correction of keratoconus. These developments are essential to continued improvements in the quality of clinical care provided to people with keratoconus.

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“…To overcome this limitation, wavefront-guided customized scleral lens may be a good option. Sabesan et al 31 reported the SD of the movement for scleral lenses designed specifically for stability (measured over a brief 20-second test window) as T54.5 Km (vector movement in x and y) and a rotation of T0.58 degrees, which is much smaller than that of soft contact lenses. In the study by Sabesan et al, 31 the customized scleral lens prosthetic device corrected the HOA of advanced keratoconic patients to normal levels and significantly improved their vision.…”

Section: Discussionmentioning

confidence: 98%