Boris Severinsky | Emory University (original) (raw)

Papers by Boris Severinsky

Optometry (St. Louis, Mo.), 2003

Stevens-Johnson syndrome (SJS) is an extreme, systemic allergic reaction with potentially morbid ... more Stevens-Johnson syndrome (SJS) is an extreme, systemic allergic reaction with potentially morbid ocular complications. The main ocular complications include severe dry eyes, corneal scarring, symblepharon, and keratopathy. Stevens-Johnson syndrome developed in a 69-year old man as a result of a hypersensitivity reaction to the drug allopurinol three years before his referral to our clinic. He had been treated, but was left with corneal scarring, hyperemia, and sore, chronic dry eyes, which necessitated continuous lubrication. The patient was fit with RGP sealed scleral contact lenses of high oxygen permeability, which produced a remarkable improvement of his signs and symptoms and allowed him to completely cease the use of artificial tears. Stevens-Johnson syndrome is a serious systemic condition in which the foremost ocular complication is severe dry eyes. This report shows that it can be managed successfully with RGP sealed scleral lenses of high permeability.

Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta perme... more Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta permeabilidad al gas (LCE-PG). Metodos: Se analizo de forma retrospectiva una base de datos con un total de 97 pacientes consecutivos (140 ojos) que fueron prescritos LCE-PG entre enero 2003 y diciembre 2008, para determinar los beneficios de llevar lentes esclerales. Todas las lentes fueron adaptadas mediante tecnica preformada y no estaban fenestras. Entre los pacientes, habia 88 (63 %) ojos queratoconos; 39 ojos (28 %) con irregularidades corneales despues de queratoplastia penetrante; diversos trastornos superfi ciales oculares: sindrome de Stevens-Johnson (SSJ), enfermedad injerto contra huesped (GVHD, en ingles) y 6 ojos (4 %) con queratopatia por exposicion; 4 ojos (3 %) con queratectasia tras cirugia refractiva, y 3 ojos (2 %) con elevado defecto refractivo. Resultados: El seguimiento medio fue de 27, 5 meses (intervalo 1-71), el tiempo medio de uso en el grupo que se adapto con exito a las LCE-PG fue de 12, 2 horas por dia (intervalo 10-16), la media de uso en el grupo que las abandono fue de 5, 8 horas (intervalo 3-8). Los pacientes con queratocono lograron una mediana de mejor agudeza visual corregida (BCVA, en ingles) de 20/32, el 84 % de los pacientes lograron una BCVA de 20/40 o superior. El grupo de posqueratoplastia logro una BCVA mediana de 20/25, el 92 % de los pacientes lograron una BCVA de 20/40 o superior. En los otros grupos, la BCVA mediana fue la siguiente: trastornos oculares superfi ciales: 20/50; queratectasia: 20/30, defecto refractario alto: 20/32. La ventilacion de fluido positiva estaba altamente asociada con una adaptacion exitosa a las LCE-PG. Veinte pacientes (21 %) no lograron usar las LCE-PG. Conclusiones: Las LCE-PG amplian las posibilidades de tratamiento de diversas anormalidades corneales. La indicacion principal para las LCE-PG es la correccion optica de una superficie corneal irregular, especialmente en queratocono y trasplante corneal.

Journal of Optometry, Jul 1, 2010

To evaluate the indications and ef cacy of high gas permeable scleral contact lenses (GP-SCL). Me... more To evaluate the indications and ef cacy of high gas permeable scleral contact lenses (GP-SCL). Methods: A total database of 97 consecutive patients (140 eyes) tted with GP-SCL between January 2003 and December 2008, was retrospectively analyzed to determine the bene ts of tting scleral lenses. All lenses were tted by preformed technique and were non-fenestrated. Patients included keratoconus-88 eyes (63 %); corneal irregularities after penetrating keratoplasty-39 eyes (28 %); various ocular surface disorders: Stevens-Johnson syndrome (SJS), graft versus host disease (GVHD) and exposure keratopathy-6 eyes (4 %); post refractive surgery keratoectasia-4 eyes (3 %), and high refractive error-3 eyes (2 %). Results: Mean follow up was 27.5 months (range 1-71), mean wearing time in successful wearers group was 12.2 hours per day (range 10-16), mean wearing time in group of wearers who dropped out using GP-SCL, was 5.8 hours (range 3-8). Keratoconus patients achieved median best corrected visual acuity (BCVA) of 20/32, 84 % of patients achieved BCVA of 20/40 or more. The post keratoplasty group achieved median BCVA of 20/25, 92 % of patients achieved BCVA of 20/40 or better. In the other groups, median BCVA was as follows: ocular surface disorders-20/50, keratoectasia-20/30, high refractive error-20/32. Positive uid-venting was highly associated with successful GP-SCL wearing. Twenty patients (21 %) failed to wear GP-SCL. Conclusions: GP-SCL's expand the management of various corneal abnormalities. The main indication for GP-SCL is optical correction of an irregular corneal surface, especially keratoconus and corneal transplant.

Contact Lens and Anterior Eye, Jun 1, 2022

PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of ped... more PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients. METHODS The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported. RESULTS Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diopters (D). In six eyes with advanced KCN (Kmax 71.8 ± 11.0 D) and three eyes with traumatic scarring, SL use obviated the need for keratoplasty. Fifteen patients (83 %) continued scleral lens wear with a mean follow-up period of 9.2 ± 7.4 months. Complications included one case of corneal graft rejection and one corneal abrasion associated with lens insertion. CONCLUSIONS The goals of SL fitting in pediatric patients are visual rehabilitation and ocular surface protection. Pediatric patients with advanced keratoconus and traumatic corneal scarring are most appreciative of the benefits of scleral lenses. The challenges associated with SL fitting and the training process did not preclude long-term SL wear.

Contact Lens and Anterior Eye, Jun 1, 2014

To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual reha... more To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years. Methods: A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed. Results: All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2 ± 2.2 years. The mean age of corneal graft was 17.6 ± 11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2 ± 10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0 ± 7.5 diopter (D) and the refractive astigmatism was 8.0 ± 4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78 ± 0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence. Conclusions: Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.

Clinical and Experimental Optometry, Nov 1, 2013

The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SH... more The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL). Methods: We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales. Results: SHmS fitting was performed 2.1 Ϯ 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 Ϯ 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 Ϯ 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 Ϯ 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes. Conclusions: SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.

International journal of keratoconus and ectatic corneal diseases, 2014

Purpose: To report successful visual rehabilitation of post refractive surgery keratoectasia shor... more Purpose: To report successful visual rehabilitation of post refractive surgery keratoectasia shortly after corneal collage crosslinking (CXL) procedure achieved with silicone hydrogel mini-scleral (SHmS) contact lens. Materials and methods: A 29-year-old woman attended to our clinic with complaints on decreased vision in her left eye. Twelve years earlier she underwent bilateral laser-assisted in situ keratomileusis (LASIK) procedure for myopia correction. Corneal topography revealed bilateral central keratoectasia with maximal keratometry values of 55.4 Diopter (D) for her right eye and 59.7 D for the left, corneal thicknesses were 422 and 443 respectively. The patient underwent an uneventful CXL procedure in her left eye and was fitted with SHmS lens 5 weeks later. The lens was designed to rest over the patients' sclera and perilimbal cornea and vault the central cornea with minimal support over it. Results: SHmS lens fitting resulted in significant subjective improvement in visual acuity (from 20/200, unaided to 20/25, contact lens corrected). The patient was able to wear the lens upto 10 hours a day with stable contact lens corrected vision. No contact lens related complications, such as edema or neovascularization were observed during 3 months follow-up period. As a result of successful restoration of vision in the CXL-treated eye, the patient was scheduled for the procedure in her other eye. Conclusion: SHmS contact lens should be considered as an option for the visual rehabilitation of corneas shortly after collagen corneal crosslinking procedure. This novel contact lens modality made from flexible and highly gas permeable material minimizes contact lens influence on corneal recovery after CXL and provides an excellent visual outcome.

Contact Lens and Anterior Eye, Feb 1, 2021

International Journal of Ophthalmology, Jan 18, 2016

BMJ open ophthalmology, Nov 1, 2021

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment ... more Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.

Cornea, May 21, 2019

Purpose: To evaluate the changes in anterior corneal topography induced by short-time wear of scl... more Purpose: To evaluate the changes in anterior corneal topography induced by short-time wear of scleral contact lenses (SLs) in keratoconic subjects with and without a history of corneal cross-linking (CXL). Methods: Nine keratoconic patients (14 eyes) were fitted with 18.5 mm SLs for optical rehabilitation. Subjects were divided into 2 groups: 7 eyes without a history of CXL (Non-CXL group) and 7 with a history of CXL (CXL group). Corneal topography was performed at baseline and after 2 and 5 hours of lens wear. The differences for simulated flat (Kflat), steep (Ksteep) and maximal (Kmax) corneal curvatures, central corneal astigmatism (CCA), and central cornea thickness were evaluated. Results: No statistically significant difference was detected between Non-CXL and CXL groups in any of these measures. Statistically significant flattening was detected in Ksteep Repeated measures analysis of variance ([RM-ANOVA), F (2,24) = 11.32, P , 0.0001], CCA [RM-ANOVA, F (2,24) = 15.34, P , 0.0001], and Kmax [RM-ANOVA, F (2,24) = 19.10, P , 0.0001). From baseline to 5 hours of SL wear, Ksteep decreased on average from 53.1 to 52.4 D, Kmax decreased from 56.7 to 55.8 D, and CCA decreased from 7.2 to 6.3 D. Kmax showed a trend toward more flattening in the Non-CXL group. Central cornea thickness showed significant thickening over time from baseline (451 mm) to 5 hours (458 mm) of SL wear [RM-ANOVA, F (1,12) = 319.3, P , 0.0001]. Conclusions: Short-term scleral lens wear in keratoconic patients may cause flattening of the anterior cornea. A history of CXL treatment does not guarantee corneal shape stability after scleral lens wear. Practitioners should be aware of these changes because scleral lens wear may mask the signs of keratoconus progression.

Eye & Contact Lens: Science & Clinical Practice

Purpose: To describe a case of a patient treated for neurotrophic keratopathy (NK) with direct co... more Purpose: To describe a case of a patient treated for neurotrophic keratopathy (NK) with direct corneal neurotization (CN), where a modification to the CN technique allowed for semiscleral contact lens use postoperatively. Observation: Our patient had successful CN with improved corneal sensation. During the procedure, a 1.0 mm gutter was created between the limbus and nerve graft to allow for semiscleral contact lens fitting. Conclusions: With the use of preoperative planning and a limbal gutter during CN, a semiscleral contact lens can serve as a well-tolerated postoperative management option to improve visual acuity and protect the corneal surface in patients with NK.

Contact lens & anterior eye : the journal of the British Contact Lens Association, 2021

PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of ped... more PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients. METHODS The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported. RESULTS Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diop...

Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta perme... more Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta permeabilidad al gas (LCE-PG). Metodos: Se analizo de forma retrospectiva una base de datos con un total de 97 pacientes consecutivos (140 ojos) que fueron prescritos LCE-PG entre enero 2003 y diciembre 2008, para determinar los beneficios de llevar lentes esclerales. Todas las lentes fueron adaptadas mediante tecnica preformada y no estaban fenestras. Entre los pacientes, habia 88 (63 %) ojos queratoconos; 39 ojos (28 %) con irregularidades corneales despues de queratoplastia penetrante; diversos trastornos superfi ciales oculares: sindrome de Stevens-Johnson (SSJ), enfermedad injerto contra huesped (GVHD, en ingles) y 6 ojos (4 %) con queratopatia por exposicion; 4 ojos (3 %) con queratectasia tras cirugia refractiva, y 3 ojos (2 %) con elevado defecto refractivo. Resultados: El seguimiento medio fue de 27, 5 meses (intervalo 1-71), el tiempo medio de uso en el grupo que se adapto con exito...

International Journal of Ophthalmology, 2016

Journal of Optometry, 2010

Optometry and Vision Science, 2016

To determine the benefits provided by centrally red-tinted contact lenses on visual acuity, contr... more To determine the benefits provided by centrally red-tinted contact lenses on visual acuity, contrast sensitivity (CS), photophobia, and quality of life in patients with degenerative retinal diseases. We evaluated the impact of centrally red-tinted hydrogel contact lenses on nine patients (aged 15 to 22 years) with severe photophobia and poor visual acuity. Each patient underwent a full eye examination with and without contact lenses, including visual acuity at distance and near, CS, eye movement recording for nystagmus, refraction, and a fundus examination. All patients completed a low vision-adapted VFQ 25-Version 2000 quality-of-life questionnaire. Seven of nine patients demonstrated improvement in binocular visual acuity as well as improvement in CS with the tinted contact lenses. Subjectively, all patients described a major improvement in their photophobia both outdoors and indoors, as well as a marked improvement in quality of life. Red-tinted contact lenses may dramatically improve visual functions, outdoor performance, and quality of life of patients suffering from retinal diseases. These lenses should be a part of the regular assessment in specialty clinics treating patients with low vision, glare, and photophobia.

Development of a new contact lens multipurpose solution: Comparative analysis of microbiological,... more Development of a new contact lens multipurpose solution: Comparative analysis of microbiological, biological and clinical performance

BMJ Open Ophthalmology

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment ... more Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-...

Optometry (St. Louis, Mo.), 2003

Stevens-Johnson syndrome (SJS) is an extreme, systemic allergic reaction with potentially morbid ... more Stevens-Johnson syndrome (SJS) is an extreme, systemic allergic reaction with potentially morbid ocular complications. The main ocular complications include severe dry eyes, corneal scarring, symblepharon, and keratopathy. Stevens-Johnson syndrome developed in a 69-year old man as a result of a hypersensitivity reaction to the drug allopurinol three years before his referral to our clinic. He had been treated, but was left with corneal scarring, hyperemia, and sore, chronic dry eyes, which necessitated continuous lubrication. The patient was fit with RGP sealed scleral contact lenses of high oxygen permeability, which produced a remarkable improvement of his signs and symptoms and allowed him to completely cease the use of artificial tears. Stevens-Johnson syndrome is a serious systemic condition in which the foremost ocular complication is severe dry eyes. This report shows that it can be managed successfully with RGP sealed scleral lenses of high permeability.

Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta perme... more Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta permeabilidad al gas (LCE-PG). Metodos: Se analizo de forma retrospectiva una base de datos con un total de 97 pacientes consecutivos (140 ojos) que fueron prescritos LCE-PG entre enero 2003 y diciembre 2008, para determinar los beneficios de llevar lentes esclerales. Todas las lentes fueron adaptadas mediante tecnica preformada y no estaban fenestras. Entre los pacientes, habia 88 (63 %) ojos queratoconos; 39 ojos (28 %) con irregularidades corneales despues de queratoplastia penetrante; diversos trastornos superfi ciales oculares: sindrome de Stevens-Johnson (SSJ), enfermedad injerto contra huesped (GVHD, en ingles) y 6 ojos (4 %) con queratopatia por exposicion; 4 ojos (3 %) con queratectasia tras cirugia refractiva, y 3 ojos (2 %) con elevado defecto refractivo. Resultados: El seguimiento medio fue de 27, 5 meses (intervalo 1-71), el tiempo medio de uso en el grupo que se adapto con exito a las LCE-PG fue de 12, 2 horas por dia (intervalo 10-16), la media de uso en el grupo que las abandono fue de 5, 8 horas (intervalo 3-8). Los pacientes con queratocono lograron una mediana de mejor agudeza visual corregida (BCVA, en ingles) de 20/32, el 84 % de los pacientes lograron una BCVA de 20/40 o superior. El grupo de posqueratoplastia logro una BCVA mediana de 20/25, el 92 % de los pacientes lograron una BCVA de 20/40 o superior. En los otros grupos, la BCVA mediana fue la siguiente: trastornos oculares superfi ciales: 20/50; queratectasia: 20/30, defecto refractario alto: 20/32. La ventilacion de fluido positiva estaba altamente asociada con una adaptacion exitosa a las LCE-PG. Veinte pacientes (21 %) no lograron usar las LCE-PG. Conclusiones: Las LCE-PG amplian las posibilidades de tratamiento de diversas anormalidades corneales. La indicacion principal para las LCE-PG es la correccion optica de una superficie corneal irregular, especialmente en queratocono y trasplante corneal.

Journal of Optometry, Jul 1, 2010

To evaluate the indications and ef cacy of high gas permeable scleral contact lenses (GP-SCL). Me... more To evaluate the indications and ef cacy of high gas permeable scleral contact lenses (GP-SCL). Methods: A total database of 97 consecutive patients (140 eyes) tted with GP-SCL between January 2003 and December 2008, was retrospectively analyzed to determine the bene ts of tting scleral lenses. All lenses were tted by preformed technique and were non-fenestrated. Patients included keratoconus-88 eyes (63 %); corneal irregularities after penetrating keratoplasty-39 eyes (28 %); various ocular surface disorders: Stevens-Johnson syndrome (SJS), graft versus host disease (GVHD) and exposure keratopathy-6 eyes (4 %); post refractive surgery keratoectasia-4 eyes (3 %), and high refractive error-3 eyes (2 %). Results: Mean follow up was 27.5 months (range 1-71), mean wearing time in successful wearers group was 12.2 hours per day (range 10-16), mean wearing time in group of wearers who dropped out using GP-SCL, was 5.8 hours (range 3-8). Keratoconus patients achieved median best corrected visual acuity (BCVA) of 20/32, 84 % of patients achieved BCVA of 20/40 or more. The post keratoplasty group achieved median BCVA of 20/25, 92 % of patients achieved BCVA of 20/40 or better. In the other groups, median BCVA was as follows: ocular surface disorders-20/50, keratoectasia-20/30, high refractive error-20/32. Positive uid-venting was highly associated with successful GP-SCL wearing. Twenty patients (21 %) failed to wear GP-SCL. Conclusions: GP-SCL's expand the management of various corneal abnormalities. The main indication for GP-SCL is optical correction of an irregular corneal surface, especially keratoconus and corneal transplant.

Contact Lens and Anterior Eye, Jun 1, 2022

PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of ped... more PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients. METHODS The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported. RESULTS Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diopters (D). In six eyes with advanced KCN (Kmax 71.8 ± 11.0 D) and three eyes with traumatic scarring, SL use obviated the need for keratoplasty. Fifteen patients (83 %) continued scleral lens wear with a mean follow-up period of 9.2 ± 7.4 months. Complications included one case of corneal graft rejection and one corneal abrasion associated with lens insertion. CONCLUSIONS The goals of SL fitting in pediatric patients are visual rehabilitation and ocular surface protection. Pediatric patients with advanced keratoconus and traumatic corneal scarring are most appreciative of the benefits of scleral lenses. The challenges associated with SL fitting and the training process did not preclude long-term SL wear.

Contact Lens and Anterior Eye, Jun 1, 2014

To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual reha... more To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years. Methods: A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed. Results: All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2 ± 2.2 years. The mean age of corneal graft was 17.6 ± 11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2 ± 10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0 ± 7.5 diopter (D) and the refractive astigmatism was 8.0 ± 4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78 ± 0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence. Conclusions: Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.

Clinical and Experimental Optometry, Nov 1, 2013

The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SH... more The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL). Methods: We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales. Results: SHmS fitting was performed 2.1 Ϯ 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 Ϯ 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 Ϯ 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 Ϯ 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes. Conclusions: SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.

International journal of keratoconus and ectatic corneal diseases, 2014

Purpose: To report successful visual rehabilitation of post refractive surgery keratoectasia shor... more Purpose: To report successful visual rehabilitation of post refractive surgery keratoectasia shortly after corneal collage crosslinking (CXL) procedure achieved with silicone hydrogel mini-scleral (SHmS) contact lens. Materials and methods: A 29-year-old woman attended to our clinic with complaints on decreased vision in her left eye. Twelve years earlier she underwent bilateral laser-assisted in situ keratomileusis (LASIK) procedure for myopia correction. Corneal topography revealed bilateral central keratoectasia with maximal keratometry values of 55.4 Diopter (D) for her right eye and 59.7 D for the left, corneal thicknesses were 422 and 443 respectively. The patient underwent an uneventful CXL procedure in her left eye and was fitted with SHmS lens 5 weeks later. The lens was designed to rest over the patients' sclera and perilimbal cornea and vault the central cornea with minimal support over it. Results: SHmS lens fitting resulted in significant subjective improvement in visual acuity (from 20/200, unaided to 20/25, contact lens corrected). The patient was able to wear the lens upto 10 hours a day with stable contact lens corrected vision. No contact lens related complications, such as edema or neovascularization were observed during 3 months follow-up period. As a result of successful restoration of vision in the CXL-treated eye, the patient was scheduled for the procedure in her other eye. Conclusion: SHmS contact lens should be considered as an option for the visual rehabilitation of corneas shortly after collagen corneal crosslinking procedure. This novel contact lens modality made from flexible and highly gas permeable material minimizes contact lens influence on corneal recovery after CXL and provides an excellent visual outcome.

Contact Lens and Anterior Eye, Feb 1, 2021

International Journal of Ophthalmology, Jan 18, 2016

BMJ open ophthalmology, Nov 1, 2021

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment ... more Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.

Cornea, May 21, 2019

Purpose: To evaluate the changes in anterior corneal topography induced by short-time wear of scl... more Purpose: To evaluate the changes in anterior corneal topography induced by short-time wear of scleral contact lenses (SLs) in keratoconic subjects with and without a history of corneal cross-linking (CXL). Methods: Nine keratoconic patients (14 eyes) were fitted with 18.5 mm SLs for optical rehabilitation. Subjects were divided into 2 groups: 7 eyes without a history of CXL (Non-CXL group) and 7 with a history of CXL (CXL group). Corneal topography was performed at baseline and after 2 and 5 hours of lens wear. The differences for simulated flat (Kflat), steep (Ksteep) and maximal (Kmax) corneal curvatures, central corneal astigmatism (CCA), and central cornea thickness were evaluated. Results: No statistically significant difference was detected between Non-CXL and CXL groups in any of these measures. Statistically significant flattening was detected in Ksteep Repeated measures analysis of variance ([RM-ANOVA), F (2,24) = 11.32, P , 0.0001], CCA [RM-ANOVA, F (2,24) = 15.34, P , 0.0001], and Kmax [RM-ANOVA, F (2,24) = 19.10, P , 0.0001). From baseline to 5 hours of SL wear, Ksteep decreased on average from 53.1 to 52.4 D, Kmax decreased from 56.7 to 55.8 D, and CCA decreased from 7.2 to 6.3 D. Kmax showed a trend toward more flattening in the Non-CXL group. Central cornea thickness showed significant thickening over time from baseline (451 mm) to 5 hours (458 mm) of SL wear [RM-ANOVA, F (1,12) = 319.3, P , 0.0001]. Conclusions: Short-term scleral lens wear in keratoconic patients may cause flattening of the anterior cornea. A history of CXL treatment does not guarantee corneal shape stability after scleral lens wear. Practitioners should be aware of these changes because scleral lens wear may mask the signs of keratoconus progression.

Eye & Contact Lens: Science & Clinical Practice

Purpose: To describe a case of a patient treated for neurotrophic keratopathy (NK) with direct co... more Purpose: To describe a case of a patient treated for neurotrophic keratopathy (NK) with direct corneal neurotization (CN), where a modification to the CN technique allowed for semiscleral contact lens use postoperatively. Observation: Our patient had successful CN with improved corneal sensation. During the procedure, a 1.0 mm gutter was created between the limbus and nerve graft to allow for semiscleral contact lens fitting. Conclusions: With the use of preoperative planning and a limbal gutter during CN, a semiscleral contact lens can serve as a well-tolerated postoperative management option to improve visual acuity and protect the corneal surface in patients with NK.

Contact lens & anterior eye : the journal of the British Contact Lens Association, 2021

PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of ped... more PURPOSE To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients. METHODS The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported. RESULTS Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diop...

Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta perme... more Objetivos: Evaluar las indicaciones y eficacia de las lentes de contacto esclerales de alta permeabilidad al gas (LCE-PG). Metodos: Se analizo de forma retrospectiva una base de datos con un total de 97 pacientes consecutivos (140 ojos) que fueron prescritos LCE-PG entre enero 2003 y diciembre 2008, para determinar los beneficios de llevar lentes esclerales. Todas las lentes fueron adaptadas mediante tecnica preformada y no estaban fenestras. Entre los pacientes, habia 88 (63 %) ojos queratoconos; 39 ojos (28 %) con irregularidades corneales despues de queratoplastia penetrante; diversos trastornos superfi ciales oculares: sindrome de Stevens-Johnson (SSJ), enfermedad injerto contra huesped (GVHD, en ingles) y 6 ojos (4 %) con queratopatia por exposicion; 4 ojos (3 %) con queratectasia tras cirugia refractiva, y 3 ojos (2 %) con elevado defecto refractivo. Resultados: El seguimiento medio fue de 27, 5 meses (intervalo 1-71), el tiempo medio de uso en el grupo que se adapto con exito...

International Journal of Ophthalmology, 2016

Journal of Optometry, 2010

Optometry and Vision Science, 2016

To determine the benefits provided by centrally red-tinted contact lenses on visual acuity, contr... more To determine the benefits provided by centrally red-tinted contact lenses on visual acuity, contrast sensitivity (CS), photophobia, and quality of life in patients with degenerative retinal diseases. We evaluated the impact of centrally red-tinted hydrogel contact lenses on nine patients (aged 15 to 22 years) with severe photophobia and poor visual acuity. Each patient underwent a full eye examination with and without contact lenses, including visual acuity at distance and near, CS, eye movement recording for nystagmus, refraction, and a fundus examination. All patients completed a low vision-adapted VFQ 25-Version 2000 quality-of-life questionnaire. Seven of nine patients demonstrated improvement in binocular visual acuity as well as improvement in CS with the tinted contact lenses. Subjectively, all patients described a major improvement in their photophobia both outdoors and indoors, as well as a marked improvement in quality of life. Red-tinted contact lenses may dramatically improve visual functions, outdoor performance, and quality of life of patients suffering from retinal diseases. These lenses should be a part of the regular assessment in specialty clinics treating patients with low vision, glare, and photophobia.

Development of a new contact lens multipurpose solution: Comparative analysis of microbiological,... more Development of a new contact lens multipurpose solution: Comparative analysis of microbiological, biological and clinical performance

BMJ Open Ophthalmology

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment ... more Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-...