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Cao K, Tian L, Ma DL, Zhao SQ, Li A, Jin ZB, Jie Y. Daily Low-Level Red Light for Spherical Equivalent Error and Axial Length in Children With Myopia: A Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:560-567. [PMID: 38662345 PMCID: PMC11046409 DOI: 10.1001/jamaophthalmol.2024.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
Importance Treatments are needed to slow progression of or reduce incidence of myopia. Objective To evaluate the efficacy and safety of daily 650-nm low-level red light (LLRL) for myopia treatment. Design, Setting, and Participants Single-masked, randomized clinical trial at 1 site in China. Baseline measurements were completed from August to September 2021. Participants were children aged 6 to 12 years with spherical equivalent error (SER) of -6 diopters (D) to 3 D. Data were analyzed from March to July 2023. Interventions Irradiation daily with 650-nm LLRL for 3 minutes twice daily 4 or more hours apart or no intervention. Main Outcomes and Measures Primary outcomes were changes in cycloplegia SER and axial length (AL) at 6- and 12-month follow-up visits. Safety was assessed on masked fundus photograph evaluations. Results A total of 336 children were randomly allocated into the LLRL group or control group in a 1:1 ratio. The control group contained 86 female patients (51.2%), and the treatment group contained 90 female patients (53.6%). The mean (SD) age, SER, and AL were 9.0 (1.9) years, -1.3 (1.5) D, and 23.8 (1.0) mm for all patients. A total of 161 (95.8%) in the LLRL group and 159 (94.6%) in the control group returned for the 6-month follow-up. A total of 157 (93.5%) in the LLRL group and 152 (90.5%) in the control group returned for the 12-month follow-up. Mean (SD) changes in SER were 0.15 (0.16) D and -0.26 (0.21) D for the LLRL group and the control group, respectively (difference, -0.41 D; 95% CI, -0.48 to -0.34 D; P < .001), at 6 months and 0.24 (0.27) D and -0.65 (0.33) D for the LLRL group and the control group, respectively (difference, -0.89 D; 95% CI, -0.95 to -0.83 D; P < .001), at 12 months. Mean (SD) changes in AL were -0.06 (0.08) mm and 0.13 (0.12) mm for the LLRL group and control group, respectively (difference, 0.19 mm; 95% CI, 0.16 to 0.22 mm; P < .001), at 6 months and -0.11 (0.10) mm and 0.26 (0.16) mm for the LLRL group and control group, respectively (difference, 0.37 mm; 95% CI, 0.34 to 0.40 mm; P < .001). Masked fundus photograph review did not identify retinal changes in either group. Conclusions and relevance These findings suggest daily use of 650-nm LLRL for 1 year can slow progression of SER and AL without safety concerns identified. Confirmation of these findings at independent sites seems warranted, as well as determining whether these effects can be sustained with or without continued treatment and whether LLRL has any effect on pathological myopia. Trial Registration ChiCTR2200058963.
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Affiliation(s)
- Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dong-Li Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shi-Qiang Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ao Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Tong W, Chen D, Chai C, Tan AM, Manotosh R. Disease patterns of microbial keratitis in Singapore: A retrospective case series. Cont Lens Anterior Eye 2019; 42:455-461. [PMID: 30808596 DOI: 10.1016/j.clae.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the disease patterns of Microbial Keratitis(MK) in patients seen in a tertiary referral hospital, to evaluate the clinical outcomes of MK and the risk factors for poorer visual outcomes. METHODS This is a retrospective case series of all culture-positive corneal scrapings between April 2012 and October 2016. A total of 230 patients(n = 230) were included into this study. Patient demographics, clinical information and microbiological characteristics of organisms are collected. RESULTS 64.3% of patients with MK are contact lens(CL) users. Among CL users, there is a preponderance of females(68.9%) and they tend to be younger (27.1 ± 10.6 years). The most frequently isolated organism in this study is Pseudomonas aeruginosa(51.7%) with 69.6% of cases belonging to CL users. MK in non-CL users tend to involve other organisms, such as coagulase-negative Staphylococci, Staphylococcus aureus and Streptococcus pneumoniae. Pseudomonas aeruginosa exhibits good sensitivity rates to ciprofloxacin, levofloxacin and gentamicin. Non-Pseudomonas organisms display similar sensitivities to ciprofloxacin, levofloxacin and gentamicin. MK in non-CL users is related to predisposing factors of prior ocular trauma and concomitant ocular pathology. They tend to have worse visual acuity(VA) on presentation and after treatment compared to CL users. Poorer VA outcome is associated with larger ulcers, increasing age, trauma and non-CL wearers. Successful clinical outcome is achieved in 97.8% of patients, with only 2.2% requiring further surgical intervention. CONCLUSION CL use alters the disease patterns of MK as well as the underlying microbiological etiology. Fluoroquinolones and aminoglycosides are good empirical antibiotics for MK treatment. Early referral to a tertiary centre will likely allow for earlier treatment, which can result in better VA outcome, especially so in patients who are older, non-CL wearers and have larger ulcers with associated trauma.
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Affiliation(s)
- Weihan Tong
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - David Chen
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - Charmaine Chai
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - Anna Marie Tan
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
| | - Ray Manotosh
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
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Shehadeh-Masha'Our R, Segev F, Barequet I, Ton Y, Garzozi H. Orthokeratology Associated Microbial Keratitis. Eur J Ophthalmol 2018; 19:133-6. [DOI: 10.1177/112067210901900120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To report the clinical course, microbiologic findings, treatment, and outcomes of overnight orthokeratology associated microbial keratitis. Methods Four cases of overnight orthokeratology associated microbial keratitis are reported. Results Four patients aged 14–23 years (mean 18 years) who had central or paracentral corneal ulcers were included. Visual acuity at presentation ranged from 20/30 to hand motion. In all cases Pseudomonas aeruginosa was cultured from corneal scrapings or storage solution. In all patients the infection resolved with intensive topical antimicrobial treatment. Final best-corrected visual acuity ranged from 20/25 to 20/200 according to the location, size, and density of the corneal scar, which complicated all cases. Conclusions Infectious keratitis is a significant, visual threatening complication of overnight orthokeratology. Eye care practitioners should be aware of this complication and educate their patients of the importance of lens hygiene and prompt medical care when symptoms or signs of keratitis appear.
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Affiliation(s)
| | - F. Segev
- Meir Hospital-Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba
| | - I.S. Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer - Israel
| | - Y. Ton
- Meir Hospital-Sackler Faculty of Medicine, Tel Aviv University, Kfar Saba
| | - H.J. Garzozi
- Bnai Zion Medical Center, Faculty of Medicine Technion, Haifa
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Abstract
Objectives: The aim of this review is to evaluate the ocular safety of orthokeratology (OrthoK) treatment of myopia correction and retardation. Data Sources: Clinical studies published in English and Chinese were identified from MEDLINE, EMBASE CNKI, CQVIP, and WANFANG DATA (all from 1980 to April 2015). The reference lists of the studies and the Science Citation Index were also searched. Selection Criteria: Relevant clinical studies including case series, case reports, patient/practitioner surveys, retrospective and prospective cohort studies, and clinical trials were all included in the review. The material of OrthoK lenses was limited to gas-permeable lens. Main Results: This review incorporated a total of 170 publications, including 58 English and 112 Chinese literature. The risk of microbial keratitis in overnight OrthoK was similar to that of other overnight modality. The most common complication was corneal staining. Other clinically insignificant side effects included epithelial iron deposit, prominent fribrillary lines, and transient changes of corneal biomechanical properties. There was no long-term effect of OrthoK on corneal endothelium. Conclusions: There is sufficient evidence to suggest that OrthoK is a safe option for myopia correction and retardation. Long-term success of OrthoK treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.
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A Meta-analysis of Central Corneal Thickness Changes With Overnight Orthokeratology. Eye Contact Lens 2016; 42:141-6. [DOI: 10.1097/icl.0000000000000132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wan KHN, Jhanji V, Young AL. Orthokeratology lens related infections. World J Ophthalmol 2014; 4:63-70. [DOI: 10.5318/wjo.v4.i3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/21/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
Orthokeratology is a reversible technique that temporarily changes the curvature of the cornea with the aim of addressing refractive errors. The United States Food and Drug Administration (FDA) granted approval for using reverse geometry contact lenses to correct myopia without any age restriction. Information from the pre-market applications to the FDA was rated as level II evidence. Another unapproved use of overnight orthokeratology is for the prevention of myopic progression. Although orthokeratology is advocated to reduce myopic progression, there are limited long-term studies with substantial evidence of its benefits. Much of this evidence comes from non-robust experimental studies using historical or self-selected controls with relative high dropout rates. Although some positive results have been published in temporarily reducing the myopic refractive error and its progression, the use of these lenses can be associated with serious complications such as microbial keratitis. Microbial keratitis is a potentially vision-threatening adverse response associated with contact lens wear. In fact, contact lens wear has been shown to be the predominant risk factor of microbial keratitis in some developed countries. Most of the published cases on overnight orthokeratology related microbial keratitis occurred in children or adolescents. Parents considering orthokeratology must make an informed decision about its temporary benefit and its potential for permanent loss of vision. The ophthalmic community should be reminded of the potential complications of orthokeratology.
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Abstract
PURPOSE The purpose of this study was to investigate the influence of overnight orthokeratology on corneal sensation. METHODS A prospective study was conducted in 34 eyes of 17 patients undergoing overnight orthokeratology. Their ages ranged from 21 to 33 years (23.5 +/- 3.2 years, mean +/- standard deviation). The logarithm of minimum angle of resolution of uncorrected visual acuity at baseline ranged from 0.22 to 1.52 (0.71 +/- 0.32), and myopic refractive error ranged from -1.00 to -4.00 D (-2.15 +/- 0.90 D). Corneal sensation was measured using the Cochet-Bonnet esthesiometer before and 3 months after the start of treatment, and each eye was tested at 5 different corneal locations: one central point and 4 peripheral points at the superior, inferior, temporal, and nasal positions 2 mm away from the limbus. RESULTS Overnight orthokeratology significantly reduced corneal sensation from 58.24 +/- 6.14 mm at baseline to 49.12 +/- 13.90 mm at 3 months after the start of treatment at the central point (P = 0.0003, Wilcoxon signed-rank test), from 58.24 +/- 6.14 to 47.65 +/- 14.37 mm at the superior point (P = 0.0002), from 57.50 +/- 6.43 to 48.09 +/- 14.82 mm at the inferior point (P = 0.0004), from 58.24 +/- 6.14 to 50.44 +/- 13.73 mm at the temporal point (P = 0.0009), and from 57.65 +/- 6.54 to 48.68 +/- 14.84 mm at the nasal point (P = 0.0022). There were no significant differences in corneal sensation among these 5 points 3 months after the treatment (P = 0.9549, Kruskal-Wallis test). The induced change in corneal sensation at the central cornea was further analyzed in relation to the amount of myopic correction. There was no significant correlation between the loss of corneal sensation and the amount of myopic correction (r = -0.211, P = 0.2245, Spearman rank correlation). CONCLUSIONS Overnight orthokeratology significantly reduced corneal sensation at both central and peripheral locations, and the reduction was not correlated with the amount of myopic correction. At present, the clinical significance of this sensory loss is not clear, but practitioners should take this effect into account in the practice of orthokeratology.
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Steinemann TL, Ehlers W, Suchecki J. Contact Lens-Related Complications. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Safety of Overnight Orthokeratology for Myopia. Ophthalmology 2008; 115:2301-2313.e1. [DOI: 10.1016/j.ophtha.2008.06.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 06/26/2008] [Indexed: 11/19/2022] Open
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Choo JD, Caroline PJ, Harlin DD, Papas EB, Holden BA. Morphologic changes in cat epithelium following continuous wear of orthokeratology lenses: A pilot study. Cont Lens Anterior Eye 2008; 31:29-37. [PMID: 17913568 DOI: 10.1016/j.clae.2007.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 07/06/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the sequence of morphologic changes over time in cat epithelium during continuous wear of orthokeratology lenses. METHODS Four 2-year-old female cats were used; one served as a no lens wear control and three wore custom designed Paragon CRT lenses for myopic and hyperopic correction in the right and left eyes, respectively. Lenses were worn continuously and animals were euthanased after 4h, 8h and 14 days. Corneal tissue was fixed then stained with hematoxylin and eosin for histologic evaluation and measurement of epithelial thickness. RESULTS Average epithelial thickness of control eyes in the centre (38+/-1 microm) and mid-periphery (3.0 mm from the centre, 38+/-2 microm) of the cornea was similar. Epithelial thickness in myopic corrected eyes showed progressive thinning in the centre and progressive thickening in the mid-periphery with increased lens wearing time. Hyperopic corrected eyes showed the opposite pattern of progressive epithelial thickening in the centre and thinning in the mid-periphery with lens wearing time. CONCLUSIONS The epithelium appears to play a major role in the changes induced by orthokeratology lenses. The epithelial effects were dependent on time and lens design. Further studies are needed to determine the mechanisms responsible for these changes.
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Ikema K, Matsumoto K, Inomata Y, Komohara Y, Miyajima S, Takeya M, Tanihara H. Induction of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs correlates with outcome of acute experimental pseudomonal keratitis. Exp Eye Res 2006; 83:1396-404. [PMID: 16968651 DOI: 10.1016/j.exer.2006.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 07/04/2006] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Abstract
This study aimed to investigate expressions and sources of matrix metalloproteinases (MMP)-2 and MMP-9, and of tissue inhibitors of MMP (TIMP)-1 and TIMP-2 in experimental Pseudomonas aeruginosa keratitis in rabbits. Pseudomonal keratitis was induced in New Zealand white rabbits, and macroscopic and microscopic examinations were performed at appropriate time points (3, 9, 12, 18, 24, 72 h). Expressions and sources of MMP-2, 9, and TIMP-1, 2 were determined using immunohistochemistry, gelatin zymography, ELISA, and RT-PCR. A typical corneal ulcer with a ring abscess was observed 12-72 h post-infection (p.i.) with P. aeruginosa. In microscopic examinations, massive inflammatory cell (mostly polymorphonuclear leukocytes, PMNs) infiltration and liquefactive necrosis were characteristic features. MMP-2 was constitutively expressed in keratocytes, and its expression was not apparently enhanced after pseudomonal infection as evidenced by zymography, immunostaining, and RT-PCR. However, MMP-9 and its activated form were induced, and were significantly enhanced 12-24 h p.i. MMP-9 appeared to derive from PMNs rather than from resident corneal cells. TIMP-1 was expressed in PMNs, macrophages, and keratocytes, and its expression was enhanced 72 h p.i. Although TIMP-2 was constitutively expressed as seen by immunostaining and RT-PCR, its concentration was below detection limits during the experiments. We demonstrated that MMP-9 was one of the important factors for corneal tissue destruction, because it was induced and significantly expressed in keratocytes and inflammatory cells after pseudomonal infection. Although TIMP-1 was expressed in later stages of infection, enhancement and activation of MMP-9 were much faster and stronger than those of TIMP-1, thereby facilitating tissue destruction leading to corneal ulceration.
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Affiliation(s)
- Kousuke Ikema
- Department of Ophthalmology and Visual Science, Kumamoto University Graduate School of Medical Sciences, Honjo, Kumamoto, Japan
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Ng LHY. Central corneal epitheliopathy in a long-term, overnight orthokeratology lens wearer: a case report. Optom Vis Sci 2006; 83:709-14. [PMID: 17041315 DOI: 10.1097/01.opx.0000236813.39603.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study is to report an unusual case of central corneal epitheliopathy (CCE) in a long-term orthokeratology lens wearer. CASE REPORT A single observational case report of a 12-year-old Chinese female myope with 3(1/2) years' experience in wearing orthokeratology lenses overnight was diagnosed with a CCE lesion during her regular orthokeratology aftercare consultation. The patient was asymptomatic. Trace or almost negative fluorescein staining was observed over the particular lesion area and, according to the clinical features of the corneal lesion, was thought to be a partially formed "dellen." The lesion healed after the use of the orthokeratology lenses was suspended for 4 months and reappeared when the patient resumed wearing the lenses. Close monitoring of the corneal condition was needed on this patient, and permanent discontinuation of the orthokeratology procedures will be considered if the signs and symptoms of the lesion worsen. DISCUSSION The etiology, clinical management and the possible differential diagnosis of the central cornea "dellen" are discussed. CONCLUSION A central corneal "dellen" may be associated with long-term, overnight use of orthokeratology lenses.
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Affiliation(s)
- Larry Hou-Yan Ng
- The Hong Kong Polytechnic University, School of Optometry, Hung Hom, Kowloon, Hong Kong, China
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Abstract
PURPOSE OF REVIEW This paper reviews the literature generated on Acanthamoeba keratitis since 1998. RECENT FINDINGS Acanthamoeba infections may be on the rise. Contact lenses are the biggest risk factor for their development. Silicone hydrogel lenses are increasingly prescribed and may be 'more sticky' to Acanthamoeba organisms. Orthokeratology for the treatment of myopia has been associated with many new cases of Acanthamoeba keratitis. Daily disposable contact lenses are the safest form of soft contact lens. Patients continue to be misdiagnosed as having herpetic keratitis. Impression cytology and confocal microscopy are newer diagnostic modalities. Topical polyhexamethylene biguanide, chlorhexidine and propamidine are the mainstay of medical therapy. Amniotic membrane may be used for cases of persistent epithelial defect and to control inflammation. Penetrating keratoplasty in a medically treated eye affords a good chance of positive outcome. SUMMARY Acanthamoeba keratitis continues to be a difficult infection to diagnose and manage. The frequency of these infections may be on the rise, most commonly associated with frequent replacement soft contact lenses. The best chance for a good outcome is based on early diagnosis, so it is important for ophthalmologists consider it in patients, especially in the contact lens wearer with suspected herpes simplex keratitis.
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Abstract
PURPOSE Despite growing evidence for clinical efficacy of orthokeratology (OK) for the temporary reduction of myopic refractive error, there has been an increasing number of reports of microbial keratitis (MK) in association with overnight wear of OK lenses. This article analyzes the first 50 cases of MK reported in overnight OK, in order to define the spectrum of the disease and to identify possible risk factors. METHODS All reported cases of presumed MK in overnight OK from 2001 onwards were included in the analysis. Demographic data of patients affected and lenses worn, and details of the disease process and possible risk factors were extracted from these reports. RESULTS Most cases of MK in OK were reported from East Asia (80%) and most affected patients were Asian (88%). The peak age range was from 9 to 15 years (61%). Although Pseudomonas aeruginosa was the predominant organism implicated in this series of cases (52%), an alarmingly high frequency of Acanthamoeba infection (30%) was found. Inappropriate lens care procedures, patient noncompliance with practitioner instructions, and persisting in lens wear despite discomfort emerged as potential risk factors. CONCLUSIONS The high frequency of MK in overnight OK in young Asian patients is likely to reflect the demographics of the OK lens-wearing population. The high frequency of Acanthamoeba infection strongly suggests that tap water rinsing should be eliminated from the lens care regimen for overnight OK. This study does not reveal the absolute incidence or relative risk of MK in overnight OK, and it is therefore premature to ascribe increased risk to this lens-wearing modality compared with other contact lens modalities.
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Affiliation(s)
- Kathleen Watt
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Abstract
PURPOSE This study was designed to report the clinical aspects, microbiologic findings, and treatment outcomes of overnight orthokeratology-associated microbial keratitis. METHODS Medical records of patients with overnight orthokeratology-associated microbial keratitis at National Taiwan University Hospital from August 2000 to October 2001were reviewed. The clinical and microbiologic characteristics and treatment outcomes were investigated. RESULTS Nine patients (in total 10 eyes) from aged 8 to 17 (mean, 12.3 +/- 2.9) years were included in this study. Eight patients had a unilateral infection and one had a bilateral infection. The initial best corrected visual acuities ranged from hand motion to 20/20. The lesions were located at the central cornea in nine eyes (90%). Smears and cultures from corneal scrapings were obtained from all patients. Four eyes were culture-positive, which included nonfermentative Gram-negative bacillus, Pseudomonas aeruginosa and Acanthamoeba. Positive smears from another two eyes revealed Gram-negative bacilli and double-walled cyst. All patients were cured using antimicrobial medications with complete re-epithelization and disappearance of corneal infiltrates. Four eyes had a final best corrected visual acuity of 20/30 or worse after a mean follow-up of 9.4 months, including one eye that had visual acuity of hand motion only. Complications included corneal opacity in all eyes, glaucoma in one eye, and cataract in one eye. CONCLUSIONS Overnight orthokeratology is an important risk factor of microbial keratitis, especially in school children. Acanthamoeba and Gram-negative bacilli, especially Pseudomonas aeruginosa, are the most common pathogens in our series. The risk of microbial keratitis after overnight orthokeratology should not be overlooked.
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Affiliation(s)
- Chia-Hui Tseng
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Abstract
PURPOSE To report an infectious complication of overnight rigid gas-permeable contact lenses. METHODS Case report and medical literature review. RESULTS A 16-year-old girl developed laboratory-confirmed acanthamoebic keratitis during orthokeratology for myopic reduction. Recent case reports suggest that Acanthamoeba is a cause of microbial keratitis associated with gas-permeable contact lenses among teenagers and young adults undergoing orthokeratology. CONCLUSIONS Acanthamoeba keratitis is an emerging complication of orthokeratology in young myopes.
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Affiliation(s)
- Kirk R Wilhelmus
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA.
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Araki-Sasaki K, Nishi I, Yonemura N, Takatsuka H, Mutoh K, Matsumoto K, Asari S, Tanihara H. Characteristics of Pseudomonas corneal infection related to orthokeratology. Cornea 2005; 24:861-3. [PMID: 16160505 DOI: 10.1097/01.ico.0000175411.05988.fa] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe a Pseudomonas aeruginosa corneal infection resulting from orthokeratology. METHODS Case report. RESULTS A 17-year-old boy wearing orthokeratology (OK) lenses was referred to our clinic because of redness in his right eye in spite of his usage of ofloxacin (OFLX) eye drops. An excavated paracentral corneal ulcer with an immune ring and hypopyon was observed. It was positioned under the paracentral steeper portion of the optic of the OK lens. Culture of the lens solution revealed P. aeruginosa. The patient was treated with topical OFLX and cefmenoxime (CMX) plus intravenous and subconjunctival injections of cefozopran (CZOP), successfully. The antibiotic susceptibility of P. aeruginosa by the disk diffusion susceptibility test was reduced under moderately hypoxic conditions. Glycocalyx slime was formed on the OK lens in vitro by P. aeruginosa isolated from the case. CONCLUSIONS Changes in P. aeruginosa susceptibility to antibiotics under moderately hypoxic conditions and glycocalyx slime formation might affect the features of OK lens-associated infections.
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Walline JJ, Holden BA, Bullimore MA, Rah MJ, Asbell PA, Barr JT, Caroline PJ, Cavanagh HD, Despotidis N, Desmond F, Koffler BH, Reeder K, Swarbrick HA, Wohl LG. The Current State of Corneal Reshaping. Eye Contact Lens 2005; 31:209-14. [PMID: 16163012 DOI: 10.1097/01.icl.0000179709.76832.4f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The application of contact lenses to alter the shape of the cornea and temporarily reduce or eliminate myopia is known as orthokeratology, corneal refractive therapy, or corneal reshaping. It was first introduced in the 1960s, but high oxygen permeable materials and more sophisticated designs allow patients to wear contact lenses only during sleep, while dramatically improving the predictability and rate of myopia reduction. Many studies have shown that most corneal reshaping patients achieve uncorrected visual acuity of 20/25 or better that lasts all day long in one to two weeks of nighttime wear. Treatment is primarily effective through central epithelial thinning and midperipheral epithelial and stromal thickening. Much remains to be learned about corneal reshaping contact lenses and their effects on the cornea. METHODS The authors reviewed existing knowledge and determined what needs to be learned in order to provide patients with appropriate informed consent prior to corneal reshaping contact lens wear. RESULTS While corneal reshaping contact lenses are effective at temporarily reducing or eliminating myopia, claims about the progress of myopia being controlled with corneal reshaping contact lenses should not be made until further studies are published in peer-reviewed literature. The incidence and prevalence of microbial keratitis related to corneal reshaping contact lens wear is not known. Any overnight wear of contact lenses increases the risk of infection, but it is not known whether the risks of microbial keratitis are greater for corneal reshaping overnight contact lens wearers than other form of overnight contact lens wear. It is also not known whether the risk of microbial keratitis is greater for children than adults, but we must determine if children are at greater risk than adults because many children are wearing corneal reshaping contact lenses. CONCLUSIONS Finally, it is recommended that ongoing education be provided to practitioners and staff regarding safety, informed consent, and prevention of potential problems, with special emphasis on the critical need to properly and thoroughly disinfect lenses that will be worn overnight.
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Affiliation(s)
- Jeffrey J Walline
- The Ohio State University College of Optometry, The Vision Cooperative Research Centre, OH, USA
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Riley C, Pence N. Forms of vision correction: demographic factors in patient attitudes and perceptions. Eye Contact Lens 2004; 30:138-43. [PMID: 15499233 DOI: 10.1097/01.icl.0000138719.59214.b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate attitudes toward current treatments for vision correction in a clinical population of adults wearing spectacles and contact lenses (CLs). METHODS Patients seen in the Indiana University Contact Lens and Primary Care Clinics in the spring of 2002 completed multiple-choice questionnaires evaluating their current device for vision, comfort, convenience, health and safety, cost, and overall satisfaction. They also rated their interest in and the convenience and health and safety of 30-day continuous wear (CW), 7-day extended wear (EW), modern orthokeratology, and LASIK and were given a forced choice on their preferred method of vision correction. RESULTS Three hundred forty-nine CL and 177 primary care patients completed questionnaires. Subjects reported high satisfaction with their current treatment. Seventy percent of glasses wearers were neutral or not interested in CLs or LASIK. CL patients were interested or very interested in orthokeratology (70%) followed by LASIK (65%), 7-day EW (51%), and 30-day CW (44%). Age and sex were the most significant factors that influenced wearing practices and attitudes, with males (especially young) indicating significantly higher use of EW than females (P = 0.0005, chi(2)). Males were also more interested in 7-day EW (P = 0.011) and 30-day CW (P = 0.001) and rated their health and safety higher (P = 0.045 and P = 0.003, respectively). CONCLUSIONS In the spring of 2002, many of these patients remained cautious about the health and safety of 7-day EW and 30-day CW CLs.
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Affiliation(s)
- Colleen Riley
- Indiana University School of Optometry, 800 East Atwater Avenue, Bloomington, IN 47405, USA.
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Ladage PM, Yamamoto N, Robertson DM, Jester JV, Petroll WM, Cavanagh HD. Pseudomonas aeruginosa corneal binding after 24-hour orthokeratology lens wear. Eye Contact Lens 2004; 30:173-8. [PMID: 15499241 DOI: 10.1097/01.icl.0000133220.32701.c8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To examine the effect of short-term 24-hr orthokeratology lens (OKL) wear on Pseudomonas aeruginosa binding, epithelial surface cell morphology, epithelial sheet thickness, and stromal thickness in a rabbit model. METHODS Seventeen New Zealand white rabbits were treated according to the Association for Research in Vision and Ophthalmology Statement for the Use of Animals in Ophthalmic and Vision Research. Partial membranectomy was performed on all rabbits 1 week before the experiments. Baseline values for epithelial and stromal thickness and epithelial surface cell size were determined by in vivo confocal microscopy in one randomly chosen eye (n = 6). One week later, rabbits were fitted in the same eye with a hyper oxygen-transmissible OKL. Twenty-four hours later, confocal microscopy was repeated. The second group of rabbits (n = 6) was fitted with an OKL in one randomly chosen eye for 24 hr. P. aeruginosa binding to the corneal epithelium was assessed for the control corneas and those exposed to the test lens. Scanning electron microscopy was performed on a third group of rabbits to assess epithelial surface damage (n = 5). RESULTS There was a statistically significant difference (P<0.001) in P. aeruginosa binding between the control (1.11 +/- 0.74 x 10(5) colony-forming units per cornea) and the OKL-wearing eyes (2.74 +/- 0.69 x 10(5) colony-forming units per cornea). The central epithelium thinned by 6.5% after lens wear (48.2 +/- 1.9 microm to 45 +/- 1.7 microm, P=0.005); however, central stromal thickness increased by 7.3% (322 +/- 22 microm to 345 +/- 29 microm, P=0.006). Compared with the baseline value, central epithelial cell size increased significantly from 1,253 +/- 140 mm(2) to 1,627 +/- 393 mm(2) (29.4%, P=0.02). Scanning electron microscopy showed increased surface epithelial damage associated with OKL wear. CONCLUSIONS This prospective, masked, pilot study showed that 24-hr hyper oxygen-transmissible OKL wear induced a statistically significant increase in P. aeruginosa binding to the epithelium of the rabbit cornea, accompanied by central epithelial thinning, stromal thickening, and surface cell damage assessed by scanning electron microscopy. Collectively, the data suggest that despite adequate lens oxygen transmissibility, the mechanical pressure inherent in the OKL design exerted on the corneal surface appears to be associated with increased adherence of P. aeruginosa to surface corneal epithelial cells, which may pose an increased risk for lens-related microbial keratitis, especially in overnight (i.e., closed-eye) wearing conditions. Future studies are needed to determine whether these results are similar in human wear and how P. aeruginosa binding during OKL wear compares with other lens-wearing modalities, such as daily or continuous soft lens wear.
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Affiliation(s)
- Patrick M Ladage
- Department of Ophthalmology, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX 75390-9057, USA
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Doughman D. Is Corneal Refractive Therapy a New Modality Whose Time Has Come or Repackaged Orthokeratology Whose Time Has Passed? Eye Contact Lens 2004; 30:219-22; discussion 230. [PMID: 15499254 DOI: 10.1097/01.icl.0000140227.51062.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
I was asked to evaluate corneal refractive therapy (CRT) as an experienced ophthalmologist, who is a corneal specialist. I reviewed the literature and listened to and talked with ophthalmologists, optometrists, and researchers using and studying CRT. I feel that CRT is safe and effective. It offers a nonsurgical option for patients who are not eligible for surgery, particularly because of age, or for those who want to correct myopia for daytime vision but do not want to have surgery or wear a contact lens. CRT can be a valuable option to provide patients in a refractive surgery practice.
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Affiliation(s)
- Donald Doughman
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN 55455, USA
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Abstract
PURPOSE This case series presents the first documented cases of infectious ulcers associated with overnight orthokeratology in North America and other less serious complications associated with overnight corneal reshaping. CASE REPORTS Five cases of adverse corneal events associated with corneal refractive therapy are described: two cases of microbial keratitis, one case of infiltrates, one case of toxic keratitis, and one corneal abrasion. CONCLUSIONS Corneal compromise and poor compliance can cause adverse events with corneal reshaping. The need for ongoing patient education is important not only for pediatric contact lens patients, but also for adults.
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Affiliation(s)
- Jacob Lang
- New England College of Optometry, Boston, MA, USA
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