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  • Scleral Lenses Reduce the Need for Corneal Transplant in Severe Keratoconus

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, February 2018

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    Koppen et al. looked at success and failure rates of scleral lens correction for severe keratoconus to determine whether this treatment could be a viable alternative to corneal transplan­tation. Their research showed that these lenses may spare many patients from the surgery.

    The authors’ retrospective case series included patients with severe kerato­conus (maximal keratometry [Kmax] value ≥ 70 D) who attended the kera­toconus clinic at Antwerp University Hospital in Belgium during a 5-year period. Excluded from participation were patients with amblyopia, mental disability, or any concomitant ocular disease that could limit visual potential.

    Scleral lens fitting was proposed for 75 eyes; Kmax ranged from 70 to 130 D (mean, 81.70 D). Eight of these eyes underwent corneal transplantation, which was required because of lens intolerance, insufficient visual acuity with the lenses, or problems handling the lenses.

    All told, scleral contact lenses were prescribed for 51 of the 75 eyes. The mean gain in visual acuity (scleral lens vs. spectacle-corrected visual acuity) was 0.54 ± 0.18 (decimal fraction, Snellen chart). Seven eyes were lost to follow-up, and lens wear was aban­doned in 4 eyes because of the patient’s inability to handle the lens. At the most recent follow-up visit, the lens was being worn in 40 eyes (mean follow-up time, 30.15 months).

    In summary, 40 (78%) of 51 eyes with severe keratoconus that otherwise would have undergone corneal trans­plantation were treated successfully with long-term wear of scleral contact lenses.

    The authors acknowledge that their keratoconus management strategy, which is focused on specialty contact lenses, may differ from that of other experts. Most importantly, patients should be educated on all treatment options, and the chosen approach should address the unique needs of each person.

    The original article can be found here.