Keratoconus continues to intrigue us. A beautiful comprehensive review article in the August edition of Contact Lens & Anterior Eye by Miguel Romero-Jiméneza, Jacinto Santodomingo-Rubidob and James Wolffsohn covers everything about this condition from classification, histopathology and etiology to different management strategies. Just one of the factors mentioned in the article is ultraviolet (UV) radiation as a possible factor that increases oxidative stress to the cornea. Protective steps potentially include the use of UV filters. However, another angle to this that may be overlooked by practitioners was addressed by Jan Bergmanson in the August 'fitting tip of the month' in Contact Lenses Today. Practitioners should not neglect to protect the eye behind the cornea from potential UV damage in people with 'pathologically (read keratoconus) or iatrogenically (read LASIK) thinned cornea', because the thinned cornea may provide less protection. Loretta Szczotka-Flynn tries to answer the question 'is keratoconus genetic?' in the Reserach Review Column in the September issue of Contact Lens Spectrum. While many questions are still unanswered, we may want to suggest to patients that '...they may have been genetically predisposed, but some form of environmental stimulus such as eye rubbing probably modulated its severity' she concludes. Finally: don't forget to check out the free resource on keratoconus management with (R)GP lenses from the University of Waterloo (Canada) - see item below in this October I-site newsletter.

Investigators in Germany analyzed and compared the effects of (R)GP and soft contact lenses on tear film protein composition versus non-contact lens wearers. Maybe not a surprise, the tear protein composition in both (R)GP and soft contact lens wearers differed significantly from the protein composition in the non-contact lens wearers. But interestingly, and maybe this is a surprise, some bio-marker intensities were significantly altered only in the group of (R)GP lens wearers.

 

A 35-year-old African-American male was previously diagnosed with keratoconus, OD > OS. He complained of decreased vision and dryness after only 2-3 hours with both piggyback and hybrid lenses. A scleral lens was tried, but even this resulted in limited success because of a pre-existing pinguecula (see item below). In some instances you may need to be creative to fit such patients - for example, with the use of a pinguecula notch in a scleral lens, like in this case. This modification can even be adapted to help accommodate a patient with a filtering bleb. Innovative and imaginative contact lens management of corneal diseases can make a big difference in a patient's quality of life. See item below and the full case report by Emily Kachinsky from Boston (USA).

I(n)-site-the-practice this month