Use of OCT and Oculus Pentacam HR as Aids to Semi-Scleral Contact Lens Fitting
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Purpose: To determine whether semi-scleral contact lenses (sSCL) can be appropriately fitted using corneal sagittal depth measurements, and to determine the impact of fit on visual acuity, effect of time on topographic corneal clearance and comfort ratings. Method: Three sSCL (Jupiter 15mm; Essilor) were fit to 20 subjects who had previous diagnoses of KC (n=18) or PMD (n=2). The fitting of the sSCL were based on the CSD measured with the Visante™ OCT at a 15mm chord on the horizontal meridian. To select the sSCL from the diagnostic trial lens set, values of 325 (lens 1), 375 (lens 2) and 425 (lens 3) μm were randomly added in sequence to the CSD. Subjects were allowed to wear each of the sSCL for 1hour. After this time, the central corneal clearance (CCC) was assessed using an UL-OCT, high contrast visual acuity (HCVA) and low contrast visual acuity (LCVA) were measured using a LogMAR VA chart and comfort ratings were obtained using a comfort rating scale (0-100). Results: The mean CSD in the horizontal meridian was 3.78±0.53 (range: 3.33-4.17) mm at a 15mm chord. The mean CCC was 190±100, 360±120 and 450±170 µm for each lens respectively (p=0.001). The mean CCC loss was 30.00±40.00, 30±60.00 and 40.00±50 µm for each lens respectively (p>0.05). The mean HCVA for lenses 1, 2 and 3 were 0.05±0.12, 0.07±0.11 and 0.11±0.08 respectively, which were significantly different (p=0.02). Tukey post hoc analysis demonstrated that this difference was only significant between lenses 1 and 3 (p=0.01). Similar findings were found for LCVA. The overall comfort rating for all three sSCL was 77.7±10.6. The comfort ratings for lenses 1, 2 and 3 were 74.9±9.2, 79.7 ±11.6 and 78.6±10.8 respectively. These differences were not significantly different (p=0.24). Conclusion: Evaluation of CSD can be used effectively to select which sSCL to fit on the eye. The results of this study suggest that lens 2 (adding 375 μm to the CSD) gave the best combination of VA and comfort ratings. However, evaluation of the fluorescein pattern must be balanced with the VA and comfort ratings for successful fitting of sSCL in a clinical setting. There was also a likelihood of topographic corneal loss after 1 hour of sSCL wear; however, this may vary depending on many factors such as scleral zone and its relationship with the scleral conjunctiva. Eyelid force, design of the contact lens and other unknown factors may play a part in the contact lens settling time and amount.