UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND

HEALTH SCIENCES
DEPARTMENT OF OPTOMETRY
ADVANCED CONTACT LENS MANAGEMENT
Literature review on short term corneal chages with
gas permeable contact lens wear in keratoconus
subjects;comparison of two fitting approach

Prepared by : Zufan Alamrie

Moderator: Haile W. (BSc, MSc,Assistant professor of
optometry and CL speacialist)
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review
 outlines
• Introduction
• Therapeutic effects of RGP for keratoconus
• RGP fitting philosophies for KC
• Rose k2 lens
• Article review

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 Brainstorm
What is keratoconus?

Why does the cornea bulge in keratoconus?

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 Introduction
Keratoconus
 is an ectatic corneal disorder characterised by
corneal steepening and apical corneal thining.
treatment options
 Spectacles
 Contact lens
 Surgery
 Riboflavin/UV treatment

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 Contact lens
• Thin, transparent lens made of materials like
PMMA,HEMA,silcon acrylic etc
• First conceived by Leonardo Davinci (1508)
• Development
1. PMMA-1940s
2. Hydrogel CL-1960s
3. RGP-1970s

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RGP contact lenses for keratoconus
• RGP lenses are those lenses made of materials
which are permeable to oxygen.
• They have inherent rigidity
• Made of polymers eg silicon
resin,polystyrene..
 important for better visual acuity,speacial
conditions like keratoconus,and for better
oxygen transmissibility.

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 Therapeutic effects of RGP on KC
• Visual quality improvement
• UV protection-Its an assumption.

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 RGP Fitting philosophies for KC
1. Apical clearance
 Small diameter and thin lenses
 No touch in the apical area,lens bearing is
directed towards the periphery.
 Reduces the risk of scarring,whorl
keratopathy and erosions
 the tightening at the periphery results
insealing of tear exchange
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 Cont..
2. Apical bearing
 Large diameter lenses
 The optic zone of CL touches on the apex of
the cone resulting in good VA
 Compresses the cone
 can result in corneal scarring and
intolerance.

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 cont
3. Three point touch or divided support
The lens bearing is shared between the apex
and mid peripheral cornea.
Minimize the risk of scar
Facilitates tear exchage
Provides good vision
Better comfort
Prolonged wearing time
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 The Objective of the Article?
• To evaluate changes in anterior corneal
topography and higher order aberrations
(HOA) after 14 days of Rigid gas
permeable(RGP) contact lens(CL) wear in
keratoconus subjects comparing two different
fitting approaches.

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 Results of earlier researches related to this
topic?
1. Patients with keratoconus experienced significant
changes in both anterior and posterior corneal
shape for 60 minutes after removal of RGP
(http:doi.org/10.1101/688929
2. Corneal topographic alteration are common in
asymptomatic contact lens wearers (j Ruiz –
montenegro
3. The use of corneal RGP contact lenses induce
topographic change on the cornea (Braun
DA,anderson penno EE,wang x,Mcculley
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 Cont..
4. Corneal curvature changes observed following
RGP contact lens wear are related to the type
of contact lens wear and duration of
worn(Wang x,Mcculley j,bowman r et al
5. Apical touch fitting causes central corneal
flattening in keratoconus (zadnik k,Barr JT
6. Apical clearance fitting causes central corneal
steepening Gunden RE,Libassi DP

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 Cont..
7. Three point touch fitting approach in
keratoconus caused corneal flattening after 2
years of wear (hwang et al

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 CL used in the Article?
Standard rose K2 lenses manufactured in
tisilfocon

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 Rose k lens
• Developed by Dr. paul rose
• Designed to fit the irregular cornea
• Multiple designs to fit all shapes of cornea

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 What makes rose k lens ideal for
keratoconus?
Complex geometry
Easy to insert,remove
Excellent health to the eye
First fit sucess

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 Rose k2
• Afamily of gas permeable lenses with speacial
feature

• 72% of patients notice an increase in acuity

with aspheric aberration control

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 The Article compares?

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Parameters the article measure to compare ?

o Steepest,flattest and average corneal power

readings
o Central corneal astigmatism
o Maximum tangential curvature
o Anterior corneal surface asphericity
o Anterior corneal surface HOA
o Thinnest corneal thickness

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 Result ?

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 Cont..

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 Cont..

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 Cont..

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 Cont..

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 Possible mechanisims for the result?

Mechanical effect
By applying a very small change to the curves
On both front and back of the lens to bring light
to a single point thus reduction aberration it
results.
 the inflammation associated with CL wear
may increase the thickness at the thinnest

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 Conclusion?
Short term rigid gas permeable CL wear
 flattens the anterior cornea
 Increases the thinnest corneal thickness
 Reduces anterior surface HOA in keratoconus
Apical touch was associated with greater
corneal flattening in comparision to three
point touch.

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 Strength and limitation?
Strength
prospective

Limitation
Fewer participants

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 Recommended hypothesis generated from
this article for the New comers?
 what is the average critical time the corneal
topography changes noticed to begin after
RGP wear??

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 References
• Braun DA, Anderson Penno EE. Effect of contact lens wear on
• central corneal thickness measurements. J Cataract Refract
• Surg. 2003;29:1319---1322.
• Google search and slideshares
• 5. Wang X, McCulley J, Bowman R, et al. Time to resolution
• of contact lens induced corneal warpage prior to refractive
• surgery. Eye Contact Lens. 2002;28:169---171.
• 6. Szczotka LB, Rabinowitz YS, Yang H. Influence of contact
• lens wear on the corneal topography of keratoconus. CLAO J.
• 1996;22:270---273.
• 7. Zadnik K, Barr JT, Steger-May K, et al. Comparison of flat and
• steep rigid contact lens fitting methods in keratoconus. Optom
• Vis Sci. 2005;82:1014---1021.
• 8. Gundel RE, Libassi DP, Zadnik K, et al. Feasibility of fitting

• go
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 THANK YOU

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