The Experts below are selected from a list of 1095 Experts worldwide ranked by ideXlab platform

Perry Rosenthal - One of the best experts on this subject based on the ideXlab platform.

  • wavefront guided Scleral Lens prosthetic device for keratoconus
    Optometry and Vision Science, 2013
    Co-Authors: Ramkumar Sabesan, Lynette Johns, Olga Tomashevskaya, Deborah S. Jacobs, Perry Rosenthal, Geunyoung Yoon
    Abstract:

    In 1961, Smirnov suggested upon quantifying the optical imperfections of the eye that it was conceivable to make Lenses to correct for them1. However, he also remarked it was highly impractical given the laborious nature of the aberration measurements. Recent technological advances have allowed the routine and accurate quantification of the ocular higher order aberrations (HOA) in normal eyes 2–4. Using these advanced methodologies, the abnormal corneal disorder of keratoconus (KC) has also been evaluated 5, 6. The main optical consequence of the corneal steepening and thinning in KC is the presence of large magnitude of HOA, around 5–6 times typically found in normal eyes, thus severely degrading retinal image quality. For a 5.7 mm pupil, Guirao et al. 7 theoretically demonstrated that an improvement by a factor of 12 in retinal image contrast at 16 c/deg could be achievable in KC compared to only 2.5-fold benefit in normals with the correction of HOA. Similarly for a 6 mm pupil, when computing the area under the modulation transfer function, Pantanelli et al.5 estimated a 4.4-fold improvement in retinal image quality in KC compared to only 2.1-fold improvement in normals with correction of HOA. Therefore, these KC patients stand to benefit to a great extent by correcting HOA. An important feature of ocular HOA in general, whether normal or highly aberrated eyes, is the inter-individual variability. Even though vertical coma and secondary astigmatism show a consistent trend across the KC population, being negative in sign, there is substantial variability in sign and magnitude of HOA. Therefore, any methodology proposed to correct for HOA must account for the particular aberration profile of the patient. Pupil size, receptoral sampling limits and post-receptoral neural factors are additional important factors to bear in mind while aiming at maximizing visual benefit with an optical correction8. In normal eyes, customized optical and surgical methods, such as adaptive optics9, 10, phase plates11 and customized laser refractive surgery12 have been proposed to compensate for HOA to provide improvement in vision. However, limited effort has been made towards developing such methodologies for KC. Presently, rigid gas permeable (RGP) corneal and Scleral Lenses are considered the standard of correction in KC. These Lenses achieve correction by masking corneal irregularities with the tear Lens between the posterior Lens surface and the anterior corneal surface. RGP corneal contact Lenses are 8.5 to 10.5 mm in diameter and cover only 75–80 % of the cornea. Mini-Scleral, corneo-Scleral and Scleral Lenses which range in diameter from 13–24 mm, depending on type or fit, may rest partly on the cornea. A Scleral Lens prosthetic device (SLPD) with diameters ranging from 17.5–24 mm is designed and fit to vault the cornea entirely. A noteworthy difference between RGP corneal Lens and SLPD is the dynamic movement of these corrective devices on the eye. A well-fitted corneal RGP Lens slides with each blink to allow for tear exchange necessary for physiological tolerance at the corneal surfaces where contact is made. Optical correction in an RGP corneal Lens is thus inherently unstable. A carefully fitted SLPD is expected to exhibit minimal movement because the bearing haptic aligns with a large area of conjunctiva overlying the sclera. Suction is avoided by precise alignment with the sclera or by creation of channels on the posterior surface13, 14. The devices used in this study were approved by the FDA in 1994 for daily wear in the treatment of irregular astigmatism and ocular surface disorders. Over the past 20 years, these devices have been referred to as the Boston Scleral Contact Lens, the Boston Scleral Lens, the Boston Scleral Lens Device, the Boston Scleral Lens Prosthetic Device, and the Boston Ocular Surface Prosthesis (BOS-P) manufactured by the Boston Foundation for Sight, Needham, MA. The clinical benefits of an SLPD in terms of improvement in visual acuity and visual function across a wide range of diagnoses including KC have been established15. By virtue of their larger diameter and broader bearing zone, these devices have been employed in the treatment of various other forms of corneal ectasia, corneal irregularity following transplant, ulcers, dry eye syndrome, ocular surface disease and others16, 17. Despite the large diameter and complexity of fitting and training in insertion and removal, high patient satisfaction in terms of wearing comfort has been observed with Scleral Lenses in the management of corneal abnormality18. Reduction of HOA has been reported in normal and KC eyes with corneal RGP Lens19–22 and SLPD23. However, since these Lenses minimize only anterior corneal aberrations, significant posterior corneal aberrations remain uncompensated24. In addition, aberrations such as coma and astigmatism are induced due to RGP corneal Lens rotation and decentration, further degrading retinal image quality. The positional stability between blinks due to the large surface coverage in SLPD makes it an ideal platform for wavefront-guided correction of HOA in KC. Soft contact Lenses with wavefront-guided surface profiles have also been shown to have potential in correcting HOA and improving vision in KC 25–27. In such a scheme of correction in two eyes with KC shown by Lopez-Gil et al., the Lens was designed according to the aberration profile of the eye, but the reduction in higher order aberration and improvement in vision were relatively small25. One possible explanation for the small average reduction in higher order aberration could be the failure to account for the decentration and rotation of the contact Lens on the eye. Static and dynamic contact Lens movements critically affect correction performance of HOA, as the Lens is not aligned to the center of the visual axis, especially in eyes with abnormal corneal surface profiles 11, 28. Sabesan et al. first demonstrated a scheme of correction in KC using soft contact Lenses where the Lens was designed by accounting for both the eye’s aberration profile and the static Lens decentration and rotation on eye26. Using these wavefront-guided customized soft contact Lenses, Sabesan et al. demonstrated an improvement in optical quality by a factor of 3 in HOA with respect to the conventional Lens on average in 3 KC patients. The improved optics resulted in an average improvement of 2.1 lines in visual acuity over the conventional correction of defocus and astigmatism alone. However, the residual higher order wavefront error was still nearly double of what is observed in normal eyes. This residual error was explained to a reasonable extent by the manufacturing error and Lens movement. To reduce the variability of Lens position by conferring mechanical stability between blinks, Chen et al.29 employed back surface customized soft contact Lenses whose posterior surface profiles were sculpted to match the anterior corneal surface in KC. On-eye performance of the back surface customized soft contact Lens demonstrated that the Lens stability was improved by a factor of 2 for horizontal and vertical decentration, and a factor of 5 in rotational orientation over conventional Lens. However, significant residual HOA induced by internal optics, especially posterior corneal surface still degraded retinal image quality. Additional customization of the front surface of the Lens thus has the potential to further correct these residual aberrations. In this article, the feasibility of correcting HOA in eyes with advanced KC using SLPD with wavefront-guided optics was investigated, with the aim of reducing optical aberrations to normal levels. SLPD was chosen as the platform for customization due to their excellent positional stability on the eye. A custom-built Shack-Hartmann wavefront sensor equipped with the large dynamic range of wavefront measurement and real time pupil imaging capability was employed to overcome the limitations of clinically available aberrometers in evaluating severely aberrated KC. Optical and visual performance was measured with SLPD on eye with conventional spherical optics and wavefront-guided optics to determine the efficacy of customized treatment.

  • Visual Benefit of Correcting Higher Order Aberrations in Keratoconus With Customized Scleral Lens
    Investigative Ophthalmology & Visual Science, 2010
    Co-Authors: Geunyoung Yoon, Lynette Johns, Olga Tomashevskaya, Deborah S. Jacobs, Perry Rosenthal
    Abstract:

    6 7 8 9 10 11 12 13 14 • Eleven keratoconic (KC) patients (13 eyes) and one normal eye were recruited in this study. • Conventional Scleral Lenses were fitted to individual eyes and aberration measurements were performed on each eye with the Scleral Lens on using a Shack-Hartmann wavefront sensor. • The aberration was calculated for the subject’s maximum natural pupil size under the mesopic illumination condition. From the measured aberration, the polychromatic modulation transfer functions (MTFs) were calculated to estimate expected improvements in retinal image quality by customizing the Scleral Lens. • Theoretical visual benefit was defined as the ratio of area under the MTFs with customized Scleral Lens to with the conventional Scleral Lens. Visual Benefit of Correcting Higher Order Aberrations in Keratoconus With Customized Scleral Lens

  • the boston Scleral Lens in the treatment of pediatric patients
    Journal of Aapos, 2008
    Co-Authors: Deborah S. Jacobs, Perry Rosenthal, Inci Gungor, Kenneth Schor
    Abstract:

    Purpose To report the use of a custom-designed, fluid-ventilated, gas-permeable Scleral Lens in the treatment of patients under 13 years of age. Methods We retrospectively reviewed the medical records of all patients under 13 years of age who were fitted with the Boston Scleral Lens at the Boston Foundation for Sight from January 1996 through June 2006. Age, sex, ophthalmic diagnosis, systemic diagnosis, prior surgical intervention, complications, Lens fit and wearing failures, and duration of Lens use are reported. Results Boston Scleral Lenses were fitted in 47 eyes of 31 patients referred after failure of conventional therapy. Patients ranged in age from 7 months to 12.92 years (mean, 7.75 years) at time of fitting. There were 16 girls and 15 boys in this group. The mean duration of documented Scleral Lens use was 24 months (range, 0-85 months). A broad range of refractive and ocular surface disorders was treated with this modality, with the vast majority of patients having ocular surface disease (27/31, 87%) rather than refractive disorders (4/31, 13%). Congenital corneal anesthesia syndromes and Stevens-Johnson syndrome each accounted for over one-third of the patients. Conclusions The Boston Scleral Lens is a custom-designed, fluid-ventilated, rigid gas-permeable Scleral Lens that vaults the cornea retaining a pool of oxygenated artificial tears over the corneal surface. The Boston Scleral Lens is a treatment option, after failure of conventional therapy, for a broad range of ocular surface and refractive disorders in the pediatric age group. Pediatric ophthalmologists should be aware of this treatment modality, particularly in the management of severe ocular surface disease.

  • boston Scleral Lens prosthetic device for treatment of severe dry eye in chronic graft versus host disease
    Cornea, 2007
    Co-Authors: Deborah S. Jacobs, Perry Rosenthal
    Abstract:

    Purpose:To determine if the Boston Scleral Lens Prosthetic Device (BSLPD) reduces symptoms and improves quality of life in patients with severe dry eye from chronic graft-versus-host disease (cGvHD).Methods:This is a noncomparative interventional case series reporting 33 consecutive patients with se

  • use of fluid ventilated gas permeable Scleral Lens sl for management of severe keratoconjunctivitis sicca secondary to chronic graft versus host disease
    Blood, 2006
    Co-Authors: Kikuchi Takahide, Perry Rosenthal, P Parker, Michael Wu, Paul A Carpenter, Barbara Stehr, Paul J Martin, Stephen J Forman
    Abstract:

    Dry eyes or keratoconjunctivitis sicca (KCS) occur in 50 % of patients (pts) with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) and may represent the only, or most significant, clinical manifestation of cGVHD in some pts. Artificial tears, long-acting ocular lubricants, punctal plugs, ophthalmic cyclosporine, topical corticosteroids, moisture chamber eyewear and oral cholinergic agents are the primary supportive therapies of ocular cGVHD. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable Scleral Lens (Boston Scleral Lens, BSL) has been effective in mitigating symptoms and resurfacing corneal erosions in pts with a variety of causes of KCS refractory to conventional therapies. Here we report outcomes in 9 pts with cGVHD after related and unrelated HCT who had severe KCS treated by fitting a BSL because of debilitating ocular discomfort, visual impairment, or keratopathy despite systemic and local therapies and other supportive care. Diagnoses at time of HCT were CML (n=3), MDS (n=2), AML (n=1), AA (n=1), CLL (n=1) and MM (n=1). Median pt age at the time of SL fitting was 56 (range, 25–64) yrs. All pts had prior cGVHD involving multiple sites that required immunosuppression therapy (IS) with prednisone, +/− calcineurin inhibitors, +/− mycophenolate mofetil or other therapies. Manifestation of cGVHD other than eyes at the time of SL fitting were skin (n=2), mouth (n=5), liver (n=3), GI (n=1), lungs (n=1) and vagina (n=1). At the time of SL, 7 pts were receiving IS and 2 pts had discontinued all IS because of resolution of other manifestation of cGVHD. The response to the SL was assessed by patient-reported ocular disability and use of ancillary eye care, and by use of the Ocular Surface Disease Index (OSDI) in 5 pts. The OSDI is a valid and reliable tool used to assess severity of dry eye symptoms and vision-related function on a 0–100 scale, with higher scores correlating with increasing symptom severity and vision-related disability. Table below presents patients-reported outcomes. The use of the BSL led to ocular improvement in all cases. No serious adverse events or infections attributable to the BSL occurred. The median OSDI available improved from 87.7 to 20.8 within 2 weeks of BSL fitting and was 12.5 (4.2–52.7) at the time of last contact, 8–23 months (median, 15.2) after BSL fitting. Seven pts were no longer disabled by KCS after the BSL. All 9 pts reported reduced use of artificial tears, and 2 of 3 who were using moisture chamber eye glasses pre BSL were able to discontinue them. One pt had significant difficulty inserting the BSL, even with assistance. We conclude that BSL can be a safe and effective procedure for pts suffering from severe cGVHD-related KCS that is refractory to other therapies.

Paul J Martin - One of the best experts on this subject based on the ideXlab platform.

  • use of fluid ventilated gas permeable Scleral Lens for management of severe keratoconjunctivitis sicca secondary to chronic graft versus host disease
    Biology of Blood and Marrow Transplantation, 2007
    Co-Authors: Kikuchi Takahide, P Parker, Michael Wu, William Hwang, Paul A Carpenter, Carina Moravec, Barbara Stehr, Paul J Martin
    Abstract:

    Abstract Keratoconjunctivitis sicca (KCS) occurs in 40%-60% of patients with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation. Although immunosuppressive therapy is the primary treatment of chronic GVHD, ocular symptoms require measures to improve ocular lubrication, decrease inflammation, and maintain mucosal integrity. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable Scleral Lens (SL) has been effective in mitigating symptoms and resurfacing corneal erosions in patients with KCS related to causes other than cGVHD. We report outcomes in 9 consecutive patients referred for SL fitting for cGVHD-related severe KCS that was refractory to standard treatments. All patients reported improvement of ocular symptoms and reduced the use of topical lubricants after SL fitting resulting from decreased evaporation. No serious adverse events or infections attributable to the SL occurred. The median Ocular Surface Disease Index improved from 81 (75-100) to 21 (6-52) within 2 weeks after SL fitting, and was 12 (2-53) at the time of last contact, 1-23 months (median, 8.0) after SL fitting. Disability related to KCS resolved in 7 patients after SL fitting. The use of SL appears to be safe and effective in patients with severe cGVHD-related KCS refractory to conventional therapies.

  • use of fluid ventilated gas permeable Scleral Lens sl for management of severe keratoconjunctivitis sicca secondary to chronic graft versus host disease
    Blood, 2006
    Co-Authors: Kikuchi Takahide, Perry Rosenthal, P Parker, Michael Wu, Paul A Carpenter, Barbara Stehr, Paul J Martin, Stephen J Forman
    Abstract:

    Dry eyes or keratoconjunctivitis sicca (KCS) occur in 50 % of patients (pts) with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) and may represent the only, or most significant, clinical manifestation of cGVHD in some pts. Artificial tears, long-acting ocular lubricants, punctal plugs, ophthalmic cyclosporine, topical corticosteroids, moisture chamber eyewear and oral cholinergic agents are the primary supportive therapies of ocular cGVHD. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable Scleral Lens (Boston Scleral Lens, BSL) has been effective in mitigating symptoms and resurfacing corneal erosions in pts with a variety of causes of KCS refractory to conventional therapies. Here we report outcomes in 9 pts with cGVHD after related and unrelated HCT who had severe KCS treated by fitting a BSL because of debilitating ocular discomfort, visual impairment, or keratopathy despite systemic and local therapies and other supportive care. Diagnoses at time of HCT were CML (n=3), MDS (n=2), AML (n=1), AA (n=1), CLL (n=1) and MM (n=1). Median pt age at the time of SL fitting was 56 (range, 25–64) yrs. All pts had prior cGVHD involving multiple sites that required immunosuppression therapy (IS) with prednisone, +/− calcineurin inhibitors, +/− mycophenolate mofetil or other therapies. Manifestation of cGVHD other than eyes at the time of SL fitting were skin (n=2), mouth (n=5), liver (n=3), GI (n=1), lungs (n=1) and vagina (n=1). At the time of SL, 7 pts were receiving IS and 2 pts had discontinued all IS because of resolution of other manifestation of cGVHD. The response to the SL was assessed by patient-reported ocular disability and use of ancillary eye care, and by use of the Ocular Surface Disease Index (OSDI) in 5 pts. The OSDI is a valid and reliable tool used to assess severity of dry eye symptoms and vision-related function on a 0–100 scale, with higher scores correlating with increasing symptom severity and vision-related disability. Table below presents patients-reported outcomes. The use of the BSL led to ocular improvement in all cases. No serious adverse events or infections attributable to the BSL occurred. The median OSDI available improved from 87.7 to 20.8 within 2 weeks of BSL fitting and was 12.5 (4.2–52.7) at the time of last contact, 8–23 months (median, 15.2) after BSL fitting. Seven pts were no longer disabled by KCS after the BSL. All 9 pts reported reduced use of artificial tears, and 2 of 3 who were using moisture chamber eye glasses pre BSL were able to discontinue them. One pt had significant difficulty inserting the BSL, even with assistance. We conclude that BSL can be a safe and effective procedure for pts suffering from severe cGVHD-related KCS that is refractory to other therapies.

Gloria B. Chiu - One of the best experts on this subject based on the ideXlab platform.

  • bacteriostatic effect of multidose preservative free buffered saline used in Scleral Lens wear
    Optometry and Vision Science, 2020
    Co-Authors: Gloria B. Chiu
    Abstract:

    SIGNIFICANCE: Scleral Lenses have become an increasingly common treatment for ocular surface disease and irregular corneas. Multidose, preservative-free saline solutions are frequently used off-label to fill Scleral Lenses. Because the fluid resides over the ocular surface during Lens wear, contaminated solutions may increase the risk of infectious complications. PURPOSE: We sought to assess the viability of skin microorganisms and pathogens associated with keratitis once introduced into a multidose preservative-free saline (MDPFS) solution containing the bacteriostatic agent boric acid (PuriLens Plus; The Lifestyle Co., Inc., Freehold, NJ). METHODS: Eleven bacterial and one yeast isolate were each inoculated to three lots of MDPFS as well as to sterile normal saline for comparison. Microorganism concentrations were enumerated at baseline and days 1, 3, 7, 14, 21, and 28. Persistence of microorganism viability was compared between MDPFS lots and between MDPFS and normal saline for each organism. RESULTS: Duration of microorganism viability was >/=24 hours in MDPFS with no significant difference in the distribution of survival duration of microorganisms in MDPFS versus normal saline (P = .15). Candida albicans concentrations declined 14 days earlier in MDPFS, whereas concentrations of viable organisms in MDPFS remained within 1 log of baseline for the longest durations for Pseudomonas aeruginosa (7 days), Escherichia coli (14 days), and Achromobacter xylosoxidans (>/=28 days). Gram-positive organism concentrations remained within 1 log of baseline for no more than 3 days. Mild lot-to-lot variation in organism concentrations was noted near the end points of viability. Bacteriostasis was demonstrated in that concentrations of all organisms remained at or below baseline levels throughout the 28-day period. CONCLUSIONS: After microbial contamination, persistence of organism viability was similar in PuriLens and normal saline. Environmental gram-negative organisms, many of which can contribute to infectious keratitis, can persist for weeks once introduced into saline solutions.

  • Effect of Scleral Lens Wear on Central Corneal Thickness and Intraocular Pressure in Patients With Ocular Surface Disease.
    Eye & Contact Lens-science and Clinical Practice, 2019
    Co-Authors: Kevin C. Shahnazi, Veronica L. Isozaki, Gloria B. Chiu
    Abstract:

    To determine the effect of Scleral Lens wear on central corneal thickness (CCT) and intraocular pressure (IOP). Twenty-five subjects (46 eyes), fit with Scleral Lenses that ranged in diameter from 17.0 to 18.0 mm, were included in this retrospective study at the University of Southern California, Department of Ophthalmology. All subjects had ocular surface disease and were categorized into the following groups based on etiology of their dry eye: chronic graft versus host disease, Stevens-Johnson syndrome, Sjögren syndrome, or general dry eye syndrome. Measurements of CCT and IOP were obtained at the initial Scleral Lens consultation (pre-CCT and pre-IOP) and at follow-up visits (post-CCT and post-IOP) immediately after Lens removal. The total average difference between pre-CCT and post-CCT was 7.19 μm (544.90±31.29 vs. 552.09±30.30 μm), which was a statistically significant increase of 1.01% (P≤0.05). On the other hand, the total average difference between pre-IOP and post-IOP was -0.89 mm Hg (14.47±3.63 vs. 13.58±3.61 mm Hg), which was not statistically significant (P≥0.05). There were no statistically significant correlations between change in CCT (ΔCCT) and visual acuity (P≥0.05), between ΔCCT or change in IOP (ΔIOP) in relation to Lens diameter (P≥0.05), between etiology of dry eye affecting ΔCCT or ΔIOP (P≥0.05), between wearing time today and ΔCCT or ΔIOP (P≥0.05), and between average wearing time (AWT) and ΔCCT (P≥0.05). In addition, there was no statistically significant correlation between AWT and ΔIOP (R=0.0796) over a range of wear time hours. There was a statistically significant increase in CCT after Scleral Lens wear in subjects with ocular surface disease, which may be attributed to subclinical hypoxic conditions created by Scleral Lens wear. No significant relationship was found between Scleral Lens wear and IOP.

  • transient corneal epithelial bullae associated with large diameter Scleral Lens wear a case series
    Contact Lens and Anterior Eye, 2018
    Co-Authors: Veronica L. Isozaki, Gloria B. Chiu
    Abstract:

    Abstract With the increased fitting of Scleral Lenses by eye care practitioners, complications with Lens wear need to be considered. Several prior studies have addressed complications specific to Scleral Lens wear and the incidence of hypoxia with extended wear, but few report the presence of epithelial bullae. This case series investigates three patients with differing ocular surface diseases, yet all developed transient epithelial bullae with concurrent large diameter Scleral Lens wear. These bullae appear to form due to weakened connections in the corneal epithelium at the level of basement membrane and Bowman’s layer and flatten within minutes of Lens removal. These bullae need to be further studied, as they can increase the patient’s risk of epithelial defects, infections, and other complications in already compromised corneas.

  • Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lens Therapy for Exposure Keratopathy.
    Eye & Contact Lens-science and Clinical Practice, 2017
    Co-Authors: Jasdeep S Chahal, Martin Heur, Gloria B. Chiu
    Abstract:

    To investigate the utility of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Scleral Lenses in patients with exposure keratopathy, with outcomes based on changes in visual acuity, visual function, and corneal staining. A retrospective interventional case series of patients evaluated and treated from September 2009 through June 2014 at a single multi-specialty institutional practice. Eighteen of 29 patients with exposure keratoconjunctivitis, lagophthalmos, ectropion, or lid retraction, referred to USC Eye Institute after failing conventional therapies completed PROSE Scleral Lens fitting and were included in the study. Visual function was assessed before and after PROSE fitting with the Ocular Surface Disease Index (OSDI) survey. Visual acuity (VA) and corneal staining changes were also evaluated before and after treatment. Visual acuity improved from 0.60±0.68 logMAR pre-PROSE to 0.25±0.34 logMAR (Z=−3.81, P=0.00014) post-PROSE, which corresponds to an improvement of about 20/80 to 20/35 on Snellen VA. Ocular Surface Disease Index scores improved from 56.54±29.75 pre-PROSE to 24.98±21.23 post-PROSE (Z=−2.98, P=0.0029), and corneal staining values decreased from 2.17±0.84 pre-PROSE to 0.64±0.70 post-PROSE (Z=−3.27, P=0.011). The results suggest that PROSE Scleral Lens therapy is effective in patients with exposure keratopathy who had failed conventional therapies and can serve as an alternative to lid surgery.

  • prosthetic replacement of the ocular surface ecosystem prose Scleral Lens for salzmann s nodular degeneration
    Saudi Journal of Ophthalmology, 2014
    Co-Authors: Gloria B. Chiu, Dianne Bach, Christos Theophanous, Martin Heur
    Abstract:

    Purpose To evaluate the use of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Scleral Lens treatment as an alternative to keratectomy in patients with symptomatic Salzmann’s nodular degeneration (SND).

Paul A Carpenter - One of the best experts on this subject based on the ideXlab platform.

  • use of fluid ventilated gas permeable Scleral Lens for management of severe keratoconjunctivitis sicca secondary to chronic graft versus host disease
    Biology of Blood and Marrow Transplantation, 2007
    Co-Authors: Kikuchi Takahide, P Parker, Michael Wu, William Hwang, Paul A Carpenter, Carina Moravec, Barbara Stehr, Paul J Martin
    Abstract:

    Abstract Keratoconjunctivitis sicca (KCS) occurs in 40%-60% of patients with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation. Although immunosuppressive therapy is the primary treatment of chronic GVHD, ocular symptoms require measures to improve ocular lubrication, decrease inflammation, and maintain mucosal integrity. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable Scleral Lens (SL) has been effective in mitigating symptoms and resurfacing corneal erosions in patients with KCS related to causes other than cGVHD. We report outcomes in 9 consecutive patients referred for SL fitting for cGVHD-related severe KCS that was refractory to standard treatments. All patients reported improvement of ocular symptoms and reduced the use of topical lubricants after SL fitting resulting from decreased evaporation. No serious adverse events or infections attributable to the SL occurred. The median Ocular Surface Disease Index improved from 81 (75-100) to 21 (6-52) within 2 weeks after SL fitting, and was 12 (2-53) at the time of last contact, 1-23 months (median, 8.0) after SL fitting. Disability related to KCS resolved in 7 patients after SL fitting. The use of SL appears to be safe and effective in patients with severe cGVHD-related KCS refractory to conventional therapies.

  • use of fluid ventilated gas permeable Scleral Lens sl for management of severe keratoconjunctivitis sicca secondary to chronic graft versus host disease
    Blood, 2006
    Co-Authors: Kikuchi Takahide, Perry Rosenthal, P Parker, Michael Wu, Paul A Carpenter, Barbara Stehr, Paul J Martin, Stephen J Forman
    Abstract:

    Dry eyes or keratoconjunctivitis sicca (KCS) occur in 50 % of patients (pts) with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) and may represent the only, or most significant, clinical manifestation of cGVHD in some pts. Artificial tears, long-acting ocular lubricants, punctal plugs, ophthalmic cyclosporine, topical corticosteroids, moisture chamber eyewear and oral cholinergic agents are the primary supportive therapies of ocular cGVHD. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable Scleral Lens (Boston Scleral Lens, BSL) has been effective in mitigating symptoms and resurfacing corneal erosions in pts with a variety of causes of KCS refractory to conventional therapies. Here we report outcomes in 9 pts with cGVHD after related and unrelated HCT who had severe KCS treated by fitting a BSL because of debilitating ocular discomfort, visual impairment, or keratopathy despite systemic and local therapies and other supportive care. Diagnoses at time of HCT were CML (n=3), MDS (n=2), AML (n=1), AA (n=1), CLL (n=1) and MM (n=1). Median pt age at the time of SL fitting was 56 (range, 25–64) yrs. All pts had prior cGVHD involving multiple sites that required immunosuppression therapy (IS) with prednisone, +/− calcineurin inhibitors, +/− mycophenolate mofetil or other therapies. Manifestation of cGVHD other than eyes at the time of SL fitting were skin (n=2), mouth (n=5), liver (n=3), GI (n=1), lungs (n=1) and vagina (n=1). At the time of SL, 7 pts were receiving IS and 2 pts had discontinued all IS because of resolution of other manifestation of cGVHD. The response to the SL was assessed by patient-reported ocular disability and use of ancillary eye care, and by use of the Ocular Surface Disease Index (OSDI) in 5 pts. The OSDI is a valid and reliable tool used to assess severity of dry eye symptoms and vision-related function on a 0–100 scale, with higher scores correlating with increasing symptom severity and vision-related disability. Table below presents patients-reported outcomes. The use of the BSL led to ocular improvement in all cases. No serious adverse events or infections attributable to the BSL occurred. The median OSDI available improved from 87.7 to 20.8 within 2 weeks of BSL fitting and was 12.5 (4.2–52.7) at the time of last contact, 8–23 months (median, 15.2) after BSL fitting. Seven pts were no longer disabled by KCS after the BSL. All 9 pts reported reduced use of artificial tears, and 2 of 3 who were using moisture chamber eye glasses pre BSL were able to discontinue them. One pt had significant difficulty inserting the BSL, even with assistance. We conclude that BSL can be a safe and effective procedure for pts suffering from severe cGVHD-related KCS that is refractory to other therapies.

Martin Heur - One of the best experts on this subject based on the ideXlab platform.