Corneal stability after discontinued soft contact lens wear

doi:10.1016/j.clae.2008.02.001

Contact Lens and Anterior Eye

Volume 31, Issue 3, June 2008, Pages 122-125

https://doi.org/10.1016/j.clae.2008.02.001 Get rights and content

Abstract

Purpose

To determine the time needed to reach corneal stability after discontinued daily wear of soft contact lenses and to identify corneal topographic and pachymetric changes during this period.

Methods

We prospectively studied the eyes of 21 consecutive soft contact lens wearers evaluated for keratorefractive surgery. Each eye was examined once immediately after lens removal, 3 and 7 days later, and weekly thereafter. At each visit, manifest refraction, keratometry, corneal topography (EyeSys Corneal Analysis system, EyeSys Laboratories, Houston, TX) and pachymetry were performed. Incidence of associated corneal warpage and changes in corneal curvature and thickness during corneal stability time were determined.

Results

Of the 42 eyes examined, 26 corneas showed no significant change after the initial evaluation (stable group). The minimum stability time was 3 days in the remaining 16 eyes (unstable group), 7 of which had significant evidence of abnormal topography. Statistical analysis showed no significant differences between two groups regarding age, sex, duration of contact lens wear, and refractive and topographic measures. The mean central corneal thickness on the final visit was significantly different between two groups (P < 0.05).

Conclusion

Contact lens induced corneal warpage may occur in a considerable proportion of soft contact lens wearers. A 2-week contact lens free period seems to be adequate for the cornea to stabilize; however, one cannot predict the minimum time needed for each individual patient. Repeating examinations to document corneal stability before refractive surgery may be a safer alternative.

Introduction

A considerable proportion of the candidates for refractive surgical procedures use soft or rigid contact lenses; some may have been wearing lenses for years. It is well documented that long-term contact lens wear may lead to corneal molding [1], [2], [3], [4], [5]. Although these changes tend to be more severe and more common among hard polymethyl methacrylate (PMMA) and rigid gas-permeable (RGP) contact lens wearers, they can also occur with soft contact lenses [5], [6]. In most cases these changes will resolve partially or completely and the cornea will recover its normal geometry after discontinuation of contact lenses. Since these changes may have a negative impact on the accuracy and predictability of the keratorefractive surgery, a contact lens free period is necessary for the cornea to stabilize. This period is usually 2–7 days for soft daily wear contact lenses, while extended wear soft contact lenses may require up to 2 weeks of discontinuation for the cornea to stabilize [7]. However, there is still no way to precisely predict the sufficient time in an individual patient [8]. Also, it is not fully understood why some corneas undergo these modifications and some not. This prospective study was designed to observe the stabilization pattern of the cornea after soft daily wear contact lens discontinuation and to determine the possible factors associated with delayed corneal stabilization.

Section snippets

Patients and methods

We prospectively studied the eyes of 21 consecutive soft daily wear contact lens wearing patients who intended to undergo refractive surgery. Exclusion criteria were a history of ocular pathology or trauma, corneal or external eye disease, history or current use of systemic immunosuppressants, antimetabolites or corticosteroids, and contact lens wear for purposes other than refractive correction. Day one evaluations, including manifest refraction, keratometry, corneal topography (EyeSys Corneal

Results

Forty-two eyes of 21 patients with a history of at least 1 year daily wear of soft contact lenses were studied. Of the 42 eyes studied, 26 eyes (62%) showed no significant refractive or keratometric changes by avoiding contact lenses (stable group). Regarding the remaining 16 eyes (unstable group), the cornea took at least 3 days to stabilize (3, 5, 6, and 2 eyes, 3, 7, 14, and 63 days, respectively).

Since the right and left eyes are correlated, only the data from the right eyes was used in the

Discussion

It is well established that contact lens wear may result in changes of corneal surface shape and physiology [1], [2], [3], [4], [5], [6], [7]. In 1965, Hartstein first coined the term “corneal warpage” to explain the contact lens induced corneal changes in 12 patients who wore PMMA contact lenses. Warpage may result from the mechanical effect of the lens on the cornea and/or contact lens interference with corneal metabolism [4]. Different studies have shown that, although more common and severe

Conclusion

It seems that discontinuation of soft daily wear contact lenses for 3 days may be inadequate to proceed to surgery. One to 2 weeks without soft contact lenses would be preferable in these patients. In addition, it should be considered that contact lens induced corneal warpage may occur even with soft daily contact lens wear. Our study did not indicate any association between risk of corneal instability and patients’ refractive or topographic data; duration of contact lens wear was also not

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This case report aims to highlight the corneal deformation induced by soft contact lens (SCL) wear, which is accompanied by changes in not only the anterior but also the posterior surface of cornea.
Cases are presented of two patients who wore non- planned replacement SCL for more than 15 years fabricated from materials with low oxygen permeability, sought a consultation with complaints of visual acuity loss in the both eyes. Anterior segment optical coherence tomography imaging demonstrated corneal deformation in the posterior as well as the anterior surface in both eyes of two patients, resulting in the diagnosis of corneal deformation induced by SCL wear. After the cessation of lens wear, there were improvements in visual acuity, anterior and posterior corneal higher-order aberrations, and changes in the anterior corneal shape, whereas the posterior corneal shape was improved in one case and remained mildly deformed in the other case.
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Contact lens wearers (24% of the overall population) were recommended to discontinue their use for a period of at least 3 weeks before eye examination in order to minimize methodology bias. In previous studies [12–14], a 2-week contact lens free period has been shown to be adequate for the cornea to stabilize. The analysis of full corneal thickness provided significant differences in the measurements of CCT, thinnest point, SN-IT 2–5 mm values and minimum-median difference values between controls and keratoconus, as expected.
To investigate the corneal epithelial thickness profiles in patients with a confirmed diagnosis of stable and progressive keratoconus.
Studio Italiano di Oftalmologia, Rome, Italy.
Observational study.
86 patients with either stable (n = 52) or progressive (n = 34) keratoconus and 182 healthy controls were enrolled in the study. Disease progression was confirmed by repeated corneal topographies over 1 year follow-up before inclusion in the study. All subjects had full corneal and epithelial thickness mapping taken by spectral domain optical coherence tomography (SD-OCT). The full corneal mapping was investigated by evaluating the central corneal thickness, the thinnest point, the superonasal-inferotemporal thickness difference and the minimum-median thickness difference. The epithelial mapping was investigated by assessing the 2 mm central thickness, the inferior paracentral (2–5 mm) thickness, and the minimum-maximum thickness difference.
No significant differences in full corneal mapping were found between stable and progressive keratoconic eyes. Of note, the inferior paracentral region of the corneal epithelium was significantly thinner in progressive (50 ± 3 μm) than stable (53 ± 4 μm) keratoconus (P < 0.001).
The SD-OCT corneal epithelial mapping was valuable for detecting local thickness changes in eyes with keratoconus. Monitoring the corneal epithelial changes across the inferior area in patients with keratoconus could be worthy for assessing disease progression.
Contribution of Fourier-domain optical coherence tomography to the diagnosis of keratoconus progression
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The exclusion criteria were any type of previous ocular surgery, including CXL, corneal rings, or keratoplasty. Contact lens wearers were instructed to discontinue their use at least 2 weeks before the examination to avoid false K and pachymetric values.23,24 This study used a Fourier-domain OCT system (RTVue, Optovue, Inc.) with a corneal adaptor module.
To determine the anatomic criteria for diagnosing keratoconus progression by corneal optical coherence tomography (OCT).
Quinze-Vingts National Ophthalmology Hospital, Paris, France.
Prospective case series.
Scanning-slit corneal topography (Orbscan II) and Fourier-domain corneal OCT (RTVue) were performed in eyes with mild to moderate keratoconus (progressive or nonprogressive [stable] ectasia) at each examination to assess the keratoconus. Disease progression was defined as an increase of at least 1.0 diopter (D) in the steepest keratometry (K) measurement over 6 months.
Of the 134 eyes of 134 patients with mild to moderate keratoconus, 98 had had progressive ectasia and 36 nonprogressive ectasia. The mean maximum K increased significantly in the progressive group (2.1 D ± 1.2 [SD], P < .0001) and remained constant in the stable group (−0.03 ± 0.39 D, P = .31). The mean thinnest corneal thickness increased significantly in the progressive group (−7.98 ± 9.3 μm, P < .0001) and remained constant in the stable group (−0.52 ± 4.21 μm, P = .22). The change in maximum K was significantly correlated with changes in the thinnest corneal thickness (r = −0.61, P < .0001). A cutoff value of −5 μm for the change in thinnest corneal thickness was identified on receiver operating characteristic curves as a threshold separating cases of progressive and stable keratoconus (area under the curve, 0.79; sensitivity, 68%; specificity, 89%).
Topographic data partly reflected the structural changes occurring during the progression of corneal ectasia. Based on the pachymetric parameters provided by OCT, corneal and epithelial thinning was correlated with corneal deformation. The use of corneal OCT might therefore improve the diagnostic sensitivity for keratoconus progression.
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To determine the usefulness of a silicone-hydrogel bandage contact lens (BCL) in the immediate postoperative period after uneventful myopic laser in-situ keratomileusis (LASIK).
The study design was randomized but not masked and data collection was prospective. This study comprised 51 consecutive myopic eyes intervened by means of the LASIK technique to compensate their refractive error. Patients were randomly assigned to two different groups. The experimental group included 24 eyes of 12 patients that were fitted with a BCL immediately after the flap replacement. The control group included 27 eyes of 14 patients with no BCL. Patients were examined 24 h after the surgery; the experimental group was analyzed immediately after the extraction of the BCL. Postoperative uncorrected distance visual acuity (UDVA) and postoperative topographic indexes were compared to baseline in both groups.
The experimental group achieved worse results in the majority of the studied variables. Postoperative UDVA was worse in experimental group (p < 0.01). Likewise, corneal asphericity (Q) was significantly higher in experimental group (p = 0.024). Topographic indexes showed higher asymmetry in the corneal maps pertaining to experimental group. Specifically, the index of surface variance (ISV) (p = 0.017) and index of vertical asymmetry (IVA) (p = 0.031) were higher in experimental group. Also, the postoperative central corneal thickness (CCT) resulted in higher values for eyes pertaining to experimental group.
The fitting of a silicone-hydrogel BCL after uneventful LASIK provokes morphological changes in the ocular structures that may lead to a worse UDVA secondary to a higher postoperative CCT and corneal edema.

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^☆: The authors declare they have no proprietary interest in any product or method mentioned in this manuscript.

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Corneal stability after discontinued soft contact lens wear☆

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Patients and methods

Results

Discussion

Conclusion

Am J Ophthalmol

Ophthalmology

Ophthalmology

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Am J Ophthalmol

Ophthalmology