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Brennan NA, Cheng X, Jong M, Bullimore MA. Commonly Held Beliefs About Myopia That Lack a Robust Evidence Base: 2025 Update. Eye Contact Lens 2025:00140068-990000000-00287. [PMID: 40397787 DOI: 10.1097/icl.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2025] [Indexed: 05/23/2025]
Abstract
PURPOSE To subject a number of areas of contention in the myopia field to evidence-based scrutiny. METHOD The 10 topics from our previous review were revisited, and nine new topics were also critiqued with emphasis on the recent peer-reviewed literature. RESULTS The following observations were made: 0.01% atropine should not be considered a frontline myopia control treatment; the role of relative peripheral hyperopia in myopia development and progression remains unclear; undercorrection probably does not slow myopia progression; treatment efficacy diminishes with time; percentage is a misleading metric of efficacy; handheld digital devices have not been proven to be myopiagenic; more time outdoors may slow myopic shift to a similar extent in children with and without myopia; daylight is responsible for only part of the impact of outdoor time; all myopia, not just high myopia, carries the risk of visually threatening complications; premyopia is a real condition. Furthermore, myopia may be considered a disease; accommodation lag may be a measurement artifact; adult myopia progression is significant; past progression is a flawed indicator to initiate myopia control; fast progression does not mean nonresponse to treatment; single vision soft contact lenses are not myopiagenic; red light therapy may not be safe; contact lens wear in children may be considered safe; rebound cannot be assessed by comparing progression during and following treatment. CONCLUSIONS The myopia field continues to evolve with some conflicts resolved, ongoing areas of confusion, and new uncertainties emerging.
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Affiliation(s)
- Noel A Brennan
- Freelance (N.A.B.), Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia; Johnson & Johnson (X.C., M.J.); School of Optometry & Vision Science (M.J.), University of New South Wales, Kensington, Australia; and College of Optometry (M.A.B.), University of Houston, Houston, TX
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Zhao N, Liang L, Hao M, Liu D, Fan Z, Wu J, Cheng Y. A case series of overnight orthokeratology-related Acanthamoeba keratitis in Northwest China: Clinical presentation, management, and outcomes. Cont Lens Anterior Eye 2025:102406. [PMID: 40097321 DOI: 10.1016/j.clae.2025.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 02/10/2025] [Accepted: 03/07/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE To report a series of overnight orthokeratology-related Acanthamoeba keratitis (OK-AK) at a teriary transfer care eye hospital in China from January 1, 2021, to February 29, 2024, and to provide a reference for its treatment. METHODS This was a single-center, retrospective case study. Records of patients with a history of OK lens use who were diagnosed with AK were analyzed. Data on clinical presentation, management, and outcomes were analyzed. We also preliminarily investigated behaviors associated with the risk of OK-AK. RESULTS A total of 11 patients were included (8 females, 3 males, 14 eyes). The mean age was 14.7 ± 3.6 years (range: 11-22 years). All patients were using OK for an average of 3.5 ± 2.4 years (range: 1-8 years) before the onset of AK. The median time from onset of symptoms to diagnosis was 5 days (range: 2-150 days). The most frequently presented symptoms were blurred vision (n=11, 100%), redness (n=8, 72.7%), and excruciating eye pain (n=8, 72.7%). Topical anti-amoebic agents (a combination of topical polyhexamethylene biguanide [PHMB], metronidazole, and voriconazole) were used in all infected eyes once the AK diagnosis was made. Systemic metronidazole and/or voriconazole were added in stromal keratitis. Eight eyes (57.1%) were cured by medication. The remaining eyes (6/14, 42.9%) underwent therapeutic keratoplasty surgery because of poor response or rapid progression of the disease. The surgeries included two lamellar keratoplasty (ALK), one deep lamellar keratoplasty (DALK), and three therapeutic penetrating keratoplasty (TPK). Recurrence occurred in two cases (2/6, 33.3%), one after 1 year following DALK and the other 3 months after TPK. All patients had improved visual acuity after treatment. CONCLUSION This findings indicate that OK-AK is a serious problem in Northwest China. AK should be suspected early in patients with OK lens use who present with clinical symptoms such as eye redness and pain. The medication cure rate in OK-AK was 57.1%. The early keratoplasty surgery rate was 42.9%, and the risk of post-operation recurrence should be a concern. Based on the above findings, clinicians need to establish a standardized follow-up system and carry out multi-dimensional user education.
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Affiliation(s)
- Na Zhao
- Department of Pharmacy, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China
| | - Le Liang
- Department of Pharmacy, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China
| | - Mi Hao
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China
| | - Dong Liu
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China
| | - Zhiyu Fan
- Department of Pharmacy, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China
| | - Jie Wu
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China; Shaanxi Institute of Ophthalmology, Xi'an 710002 Shaanxi Province, China; Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an 710002 Shaanxi Province, China
| | - Yan Cheng
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi'an No.1 Hospital, Xi'an 710002 Shaanxi Province, China; Shaanxi Institute of Ophthalmology, Xi'an 710002 Shaanxi Province, China; Ophthalmic Disease Clinical Medical Research Center of Shaanxi, Xi'an 710002 Shaanxi Province, China.
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Jung S, Eom Y, Song JS, Hyon JY, Jeon HS. Clinical Features and Visual Outcome of Infectious Keratitis Associated with Orthokeratology Lens in Korean Pediatric Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:399-412. [PMID: 39174012 PMCID: PMC11491801 DOI: 10.3341/kjo.2024.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/15/2024] [Accepted: 08/22/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE To investigate the clinical features and visual outcome of infectious keratitis associated with orthokeratology (Ortho-K) lens in Korean pediatric patients. METHODS We retrospectively reviewed medical records of patients diagnosed with Ortho-K lens-related infectious keratitis from June 2005 to April 2020 at a tertiary referral hospital. Patients' demographics, clinical features, microbiological evaluation, and treatment methods were assessed, and factors related to final visual outcomes were analyzed. RESULTS The study included 26 eyes from 26 patients (19 female and 7 male patients; mean age, 11.9 years), with an average Ortho-K lens wear duration of 33.7 ± 21.2 months. The highest number of cases occurred in summer (11 of 26 cases, 42.3%). Central or paracentral corneal lesions were observed in 25 cases (96.2%), with a mean corneal epithelial defect size of 5.13 mm2. Pseudomonas aeruginosa was the most commonly isolated organism (n = 5), followed by Serratia marcescens (n = 4). All patients responded to medical treatment without needing surgical intervention. 72% of cases achieved favorable visual outcomes (Snellen best-corrected visual acuity [BCVA] >6 / 12), while 8% experienced severe visual impairment (Snellen BCVA ≤6 / 60) due to residual central corneal opacities. Multivariable analysis showed that non-summer seasons (p = 0.043), duration from symptom onset to presentation (p = 0.040), and corneal epithelial defect size (p = 0.002) were significantly associated with final logarithm of the minimum angle of resolution BCVA. Failed autorefraction at presentation due to an Ortho-K-related infectious keratitis lesion was a significant predictor of poor final visual outcome (Snellen BCVA ≤6 / 12; odds ratio, 38.995; p = 0.030). CONCLUSIONS Ortho-K lens-related infectious keratitis can lead to permanent corneal opacities and potentially devastating visual outcomes in children. Delayed time to presentation, large corneal lesions, failure of autorefraction, and non-summer seasons were associated with poorer outcomes. Proper education and early detection would be key to safe use of orthokeratology lenses in pediatric patients.
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Affiliation(s)
- Sangwon Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Korean University College of Medicine, Ansan,
Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University Guro Hospital, Korean University College of Medicine, Seoul,
Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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Kikuchi Y, Toshida H, Ono J. A Case of Bacterial Keratitis in a Patient Using Orthokeratology and Soft Contact Lenses. Cureus 2024; 16:e68717. [PMID: 39376882 PMCID: PMC11456984 DOI: 10.7759/cureus.68717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/09/2024] Open
Abstract
A 63-year-old male with high myopia developed sudden visual loss, eyelid swelling, eye pain, discharge, and tearing in his left eye while wearing soft contact lenses (CLs) during the day and orthokeratology lenses at night. At the initial visit, his corrected visual acuity in the left eye was 20/1000, with a ring-shaped ulcer in the central cornea, corneal infiltration across the entire cornea, and conjunctival hyperemia. Pseudomonas aeruginosa was detected from corneal scrapings, and after antibiotic treatment, the ulcer healed with corneal opacity remaining. On the 60th day, corrected visual acuity of 20/20 was achieved with rigid gas-permeable CLs. To prevent CL-related ocular complications, eye care professionals must carefully evaluate the suitability of all CLs, including orthokeratology.
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Affiliation(s)
- Yota Kikuchi
- Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, JPN
| | - Hiroshi Toshida
- Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, JPN
| | - Junji Ono
- Ophthalmology, Ono Eye Clinic, Shizuoka, JPN
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Sartor L, Hunter DS, Vo ML, Samarawickrama C. Benefits and risks of orthokeratology treatment: a systematic review and meta-analysis. Int Ophthalmol 2024; 44:239. [PMID: 38904856 PMCID: PMC11192849 DOI: 10.1007/s10792-024-03175-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in children and adults. METHODS A systematic search of Cochrane Central Register of Controlled Trials, Pubmed, Embase and Ovid was conducted from database inception to 22nd August 2021. Studies that reported on risks, visual and ocular biometric effects of OK in patients > 5 years of age with myopia (- 0.75 to - 6.00D) were included. Main outcomes are change in axial length and any adverse event. RESULTS Fourty-five papers were included in this systematic review and meta-analysis. The quality of data was variable and of moderate certainty, and selection bias likely skewed the results towards a relative benefit for OK. The rate of axial elongation in children was lower for OK treatment compared to other treatment modalities at one year (MD - 0.16 mm, 95% CI - 0.25 to - 0.07). Rate of change in axial length in children rebounded after OK discontinuation compared to participants who continued treatment (MD 0.10 mm, 95% CI 0.06 to 0.14). Adults and children wearing OK were up to 3.79 times more likely to experience an adverse event when compared with conventional contact lenses (OR 3.79, 95% CI 1.24 to ll.), though this evidence base is underdeveloped and requires additional well-designed studies for substantial conclusions to be drawn. CONCLUSIONS OK arrests myopia progression while in use, however, there remain unanswered questions about the optimal duration of treatment, discontinuation effects and long-term risk for adverse events.
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Affiliation(s)
- Lauren Sartor
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia
| | - Damien S Hunter
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mai Linh Vo
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chameen Samarawickrama
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia.
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Eppenberger LS, Grzybowski A, Schmetterer L, Ang M. Myopia Control: Are We Ready for an Evidence Based Approach? Ophthalmol Ther 2024; 13:1453-1477. [PMID: 38710983 PMCID: PMC11109072 DOI: 10.1007/s40123-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs. METHODS A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected. RESULTS From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures. CONCLUSION Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.
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Affiliation(s)
- Leila Sara Eppenberger
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Poznan, Poland
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore.
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Yamasaki K, Dantam J, Sasanuma K, Hisamura R, Mizuno Y, Hui A, Jones L. Impact of in vitro lens deposition and removal on bacterial adhesion to orthokeratology contact lenses. Cont Lens Anterior Eye 2024; 47:102104. [PMID: 38161140 DOI: 10.1016/j.clae.2023.102104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to explore the impact of several contact lens (CL) care solutions on the removal of proteins and lipids, and how deposit removal impacts bacterial adhesion and solution disinfection. METHODS Lysozyme and lipid deposition on three ortho-k (rigid) and two soft CL materials were evaluated using an ELISA kit and gas chromatography respectively. Bacterial adhesion to a fluorosilicone acrylate material using Pseudomonas aeruginosa with various compositions of artificial tear solutions (ATS), including with denatured proteins, was also investigated. The impact of deposition of the different formulations of ATS on biofilm formation was explored using cover slips. Finally, the lysozyme and lipid cleaning efficacy and disinfection efficacy against P. aeruginosa and Staphylococcus aureus of four different contact lens care solutions were studied using qualitative analysis. RESULTS While maximum lysozyme deposition was observed with the fluorosilicone acrylate material (327.25 ± 54.25 µg/lens), the highest amount of lipid deposition was recorded with a fluoro-siloxanyl styrene material (134.71 ± 19.87 µg/lens). Adhesion of P. aeruginosa to fluorosilicone acrylate lenses and biofilm formation on cover slips were significantly greater with the addition of denatured proteins and lipids. Of the four contact lens care solutions investigated, the solution based on povidone-iodine removed both denatured lysozyme and lipid deposits and could effectively disinfect against P. aeruginosa and S. aureus when contaminated with denatured proteins and lipids. In contrast, the peroxide-based solution was able to inhibit P. aeruginosa growth only, while the two multipurpose solutions were unable to disinfect lenses contaminated with denatured proteins and lipids. CONCLUSION Bacterial adhesion and biofilm formation is influenced by components within artificial tear solutions depositing on lenses, including denatured proteins and lipids, which also affects disinfection. The ability of different solutions to remove these deposits should be considered when selecting systems to clean and disinfect ortho-k lenses.
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Affiliation(s)
| | - Jaya Dantam
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | | | | | - Yohei Mizuno
- Kobe Research Center, OPHTECS Corporation, Kobe, Japan
| | - Alex Hui
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research (CEVR), Hong Kong Special Administrative Region, Hong Kong
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Abstract
SIGNIFICANCE The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
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Lin H, Khaliddin N. Different Outcomes of Acanthamoeba Keratitis: A Case Series. Cureus 2023; 15:e48129. [PMID: 38046722 PMCID: PMC10692316 DOI: 10.7759/cureus.48129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Acanthamoeba keratitis is a potentially sight-threatening infection of the cornea that can lead to blindness. Over the past few decades, there has been a rise in the reported cases worldwide, which is in line with the increase of contact lens wearers. Here, we present three cases of Acanthamoeba keratitis with different outcomes.
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Affiliation(s)
- Hui Lin
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, MYS
| | - Nurliza Khaliddin
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, MYS
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Singh V, Lallu J, Ramachandran N, Kim BZ, McKelvie J. Orthokeratology-related Acanthamoeba keratitis in a 13-year-old. Clin Exp Optom 2023; 106:800-802. [PMID: 35999057 DOI: 10.1080/08164622.2022.2111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Vidit Singh
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - Jagrut Lallu
- Department of Optometry, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Optometry, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | | | - Bia Z Kim
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - James McKelvie
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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SLAMF7/STAT6 Pathway Inhibits Innate Immune Response in Late-Stage Human Acanthamoeba Keratitis: A Comparative Transcriptome Analysis. Microorganisms 2023; 11:microorganisms11020365. [PMID: 36838330 PMCID: PMC9961001 DOI: 10.3390/microorganisms11020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a blinding corneal infection caused by the protozoan Acanthamoeba. The long-term course of AK suggests the host immunity could not kill Acanthamoeba rapidly. The immune status is still unclear in the late stage of AK. The comparative transcriptome analysis was made based on the bulk RNA sequencing of cornea tissues from AK patients and donors. Differentially expressed genes and enriched signaling pathways were calculated. CIBERSORT algorithm was used for immune infiltration analysis of cornea tissue between AK and normal controls. A total of 2668 differentially expressed genes, including 1477 upregulated genes and 1191 downregulated genes, were detected. Gene Ontology analysis revealed that the pathways were significantly enriched in leukocyte migration, regulation of T-cell activation, the external side of plasma membrane, collagen-containing extracellular matrix, immune receptor activity, and cytokine binding. The Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that the pathways were significantly enriched in the cytokine-cytokine receptor interaction, hematopoietic cell lineage, and Staphylococcus aureus infection pathway. The immune infiltration profiles varied little between AK and normal controls. Compared with normal tissue, cornea tissue of AK contained a higher proportion of M0 macrophages and CD8 T cells, while resting memory CD4 T cells contributed to a relatively lower portion (p < 0.05). Finally, the expression levels of cell markers and SLAMF7/STAT6 pathway were confirmed by histopathology examinations, RT-qPCR, and Western blot.
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Toshida H, Sadamatsu Y. A Case of Herpetic Keratitis in an Orthokeratology Contact Lens Wearer. Cureus 2022; 14:e27388. [PMID: 36046321 PMCID: PMC9419115 DOI: 10.7759/cureus.27388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/05/2022] Open
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Polat HK, Kurt N, Aytekin E, Bozdağ Pehlivan S, Çalış S. Novel Drug Delivery Systems to Improve the Treatment of Keratitis. J Ocul Pharmacol Ther 2022; 38:376-395. [PMID: 35763406 DOI: 10.1089/jop.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Keratitis is a disease characterized by inflammation of the cornea caused by different pathogens. It can cause serious visual morbidity if not treated quickly. Depending on the pathogen causing keratitis, eye drops containing antibacterial, antifungal, or antiviral agents such as besiloxacin, moxifloxacin, ofloxacin, voriconazol, econazole, fluconazole, and acyclovir are used, and these drops need to be applied frequently due to their low bioavailability. Studies are carried out on formulations with extended residence time in the cornea and increased permeability. These formulations include various new drug delivery systems such as inserts, nanoparticles, liposomes, niosomes, cubosomes, microemulsions, in situ gels, contact lenses, nanostructured lipid carriers, carbon quantum dots, and microneedles. Ex vivo and in vivo studies with these formulations have shown that the residence time of the active substances in the cornea is prolonged, and their ocular bioavailability is increased. In addition, in vivo studies have shown that these formulations successfully treat keratitis. However, it has been observed that fluoroquinolones are used in most of the studies; similar drug delivery systems are generally preferred for antifungal drugs, and studies for viral and acanthameba keratitis are limited. There is a need for new studies on different types of keratitis and different drug active substances. At the same time, proving the efficacy of drug delivery systems, which give promising results in in vivo animal models, with clinical studies is of great importance for progress in the treatment of keratitis.
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Affiliation(s)
- Heybet Kerem Polat
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Nihat Kurt
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Eren Aytekin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sibel Bozdağ Pehlivan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sema Çalış
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Hsu CC, Kuo YS, Lin PY, Chen KH. Overnight orthokeratology-associated Acanthamoeba keratitis at a tertiary referral hospital in Taiwan: A retrospective case-control study. J Chin Med Assoc 2022; 85:381-387. [PMID: 35259136 DOI: 10.1097/jcma.0000000000000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acanthamoeba keratitis (AK) is a vision-threatening disease, usually associated with contact lens (CL) wear. As overnight orthokeratology (OOK) is increasingly used to control myopia, we have found incidence of OOK-associated AK is increasing. This study aimed to investigate the clinical presentation and visual outcomes of OOK-associated AK. METHODS Demographic characteristics, clinical features, and treatment outcomes were collected by reviewing the medical charts of CL-associated AK patients (n = 35) diagnosed at Taipei Veterans General Hospital from 2001 to 2016. Cases were OOK-associated AK patients (n = 13), and controls were all other CL-associated AK patients (n = 22). Student t tests and chi-square tests were used to compare cases and controls. Linear regression analyses were used to identify factors associated with the final visual outcome in CL-associated AK. RESULTS OOK-associated AK accounted for half of all CL-associated AK after 2010. OOK-associated AK patients and other CL-associated patients had similar best-corrected logarithm of the minimum angle of resolution visual acuity (BCLVA) before treatment (1.10 ± 0.75 vs 1.13 ± 0.76, p = 0.893), but OOK-associated AK patients were younger (17.15 ± 3.21 vs 26.36 ± 12.81 years, p = 0.004), had less severe disease (ring infiltration, 0% vs 31.82%, p = 0.023), and had better post-treatment BCLVA (0.06 ± 0.15 vs 0.51 ± 0.95, p = 0.041). Multiple linear regression analysis showed that better BCLVA after treatment in CL-associated AK was associated with initial presentation without ring infiltration (p = 0.002) but not with OOK use itself (p = 0.793). Twenty-six of 35 CL-associated AK patients had final BCLVA equal to or better than 0.10 (Snellen visual acuity of 6/7.5). All 13 OOK-associated AK cases were treated with chlorhexidine 0.02% ± voriconazole 1% ± oral voriconazole, and 12 of these patients had final BCLVA equal to or better than 0.10. CONCLUSION Most CL-associated AK patients had satisfactory visual outcomes. Half of AK at our hospital is OOK-associated since 2010. Early diagnosis and correct treatment may be the reason why OOK-associated AK patients had better vision prognosis.
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Affiliation(s)
- Chih-Chien Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yih-Shiuan Kuo
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ko-Hua Chen
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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15
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Myopia-correcting lenses decrease eye fatigue in a visual search task for both adolescents and adults. PLoS One 2021; 16:e0258441. [PMID: 34644337 PMCID: PMC8513897 DOI: 10.1371/journal.pone.0258441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
The steady, world-wide increase in myopia prevalence in children over the past decades has raised concerns. As an early intervention for axial-length-related myopia, correcting lenses have been developed (such as Defocus Incorporated Multiple Segment (DIMS) lenses), which have been shown to be effective in slowing myopia progression. Beyond this direct effect, however, it is not known whether such lenses also affect other aspects important to the wearer, such as eye fatigue, and how such effects may differ across age, as these lenses so far are typically only tested with adolescents. In the present work, we therefore investigated perceived fatigue levels according to lens type (normal vs DIMS) and age (adolescents vs adults) in a demanding visual search task ("Finding Wally") at two difficulty levels (easy vs difficult). Whereas age and difficulty did not result in significant differences in eye fatigue, we found a clear reduction of fatigue levels in both age groups when wearing the correcting lenses. Hence, the additional accommodation of these lens types may result in less strain in a task requiring sustained eye movements at near viewing distances.
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16
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Klaver C, Polling JR. Myopia management in the Netherlands. Ophthalmic Physiol Opt 2021; 40:230-240. [PMID: 32202320 DOI: 10.1111/opo.12676] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A trend that myopia is becoming gradually more common is shown in studies worldwide. Highest frequencies have been found in East Asian urban populations (96.5%) but also a study in Europe shows that nearly half of the 25-29 year olds has myopia. With the increase in prevalence, high myopia, i.e. a spherical equivalent of -6 or more and an axial length of 26 mm or more is also on the rise. High myopia particularly carries a significant risk of ocular pathology related to the long axial length. This highlights the need for myopia management in children with progressive myopia, in particular progression to high myopia. RECENT FINDINGS During the last decade, many intervention studies for myopia progression have emerged. Although lifestyle adjustments are effective, pharmacological and optical interventions have shown the highest efficacy on reduction of eye growth. High concentration atropine (0.5%-1.0%) shows the most reduction in axial length progression, but has drawbacks of light sensitivity and loss of accommodation. Nevertheless, when these side effects are mitigated by multifocal photochromatic glasses, the long-term adherence to high dose atropine is high. Lower concentrations of atropine are less effective, but have less side effects. Studies on optical interventions have reported reduction of progression for Ortho-K and multifocal contact lenses, but are in need for replication in larger studies with longer duration. SUMMARY The field of myopia management is rapidly evolving, and a position on the best approach for daily clinics is desirable. Over the last 10 years, our team of clinical researchers has developed a strategy which involves decision-making based on age, axial length, position on the axial length growth chart, progression rate, risk of high myopia, risk profile based on lifestyle and familial risk, side effects, and individual preference. This personalised approach ensures the most optimal long-term myopia control, and helps fight against visual impairment and blindness in the next generations of elderly.
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Affiliation(s)
- Caroline Klaver
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, the Netherlands
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17
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Bullimore MA, Mirsayafov DS, Khurai AR, Kononov LB, Asatrian SP, Shmakov AN, Richdale K, Gorev VV. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens 2021; 47:420-425. [PMID: 34050085 DOI: 10.1097/icl.0000000000000801] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To estimate the incidence of microbial keratitis in children wearing overnight orthokeratology lenses in Moscow, Russia. METHODS To estimate the number of children wearing overnight orthokeratology lenses in 2018, 1,368 patient records from 13 Doctors Lens clinics were selected at random and extrapolated to the entire patient base. To identify cases of microbial keratitis, all episodes of infiltrative keratitis from Morozovskaya City Children's Clinical Hospital in 2018 were recorded and adjudicated by three experienced ophthalmologists. Incidence was calculated as the number of cases divided by the estimated number of wearers. RESULTS There were 23,049 overnight orthokeratology fits between 2010 and 2018. Among the 1,368 records surveyed, 1,078 (79%) were younger than 18 years at initial fitting. Based on a 7% or 10% annual discontinuation rate, the estimated number of children wearing lenses in 2018 was 10,307 or 9,422, respectively. During 2018, there were 139 cases of corneal infiltrative keratitis in children and 45 were adjudicated as microbial keratitis (32%). Of these, 20 cases were associated with contact lens wear (44%): 15 soft lens wearers (33%) and 5 overnight orthokeratology wearers (11%). Based on the 5 cases and assuming a 7% or 10% discontinuation rate, the annual incidence is 4.9 (95% confidence interval[CI]: 2.1-11.4) or 5.3 (95% CI: 2.3-12.4) per 10,000 patient years. CONCLUSION The incidence of microbial keratitis in children wearing overnight orthokeratology is lower than a previous United States study and similar to rates associated with use of daily wear soft contact lenses.
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Affiliation(s)
- Mark A Bullimore
- University of Houston (M.A.B., K.R.), College of Optometry, Houston, TX; Morozovskaya City Children's Clinical Hospital (L.B.K., S.P.A., V.V.G.), Moscow, Russian Federation ; and Doctor Lens Consulting, Ltd. (D.S.M., A.R.K., A.N.S.), Moscow, Russian Federation
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18
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Wei Z, Cao K, Wang L, Baudouin C, Labbé A, Liang Q. Corneal Changes in Acanthamoeba Keratitis at Various Levels of Severity: An In Vivo Confocal Microscopic Study. Transl Vis Sci Technol 2021; 10:10. [PMID: 34110388 PMCID: PMC8196423 DOI: 10.1167/tvst.10.7.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the relationship between Acanthamoeba cysts and inflammatory cells in Acanthamoeba keratitis (AK) by in vivo confocal microscopy (IVCM). Methods A case-control study included 30 patients with AK and 20 normal controls. The severity of the AK was divided into mild, moderate, and severe. The central cornea and four standard quadrants of the peripheral cornea were imaged by IVCM. The cyst infiltration and dendritic cell (DC) density and maturity (size, length, field, and number of dendrites) were quantified. The relationship between clinical severity, cyst density, and DC alterations was characterized by Spearman correlation analysis. Results The maximum cyst density in the mild, moderate, and severe groups was 31.3 cysts/mm2 (17.2-32.8), 62.5 cysts/mm2 (59.3-103.1), and 162.5 cysts/mm2 (65.6-215.6), respectively. Compared to normal participants, a significant increase in the mean corneal DC density was detected in patients with AK (290.2 ± 97.0 vs. 25.3 ± 8.3 cells/mm2; P < 0.001). Patients with AK presented an increase in median DC size (178.3 vs. 63.6 µm2/cell, P < 0.001), median DC field (518.1 vs. 256.6 µm2/cell, P = 0.008), and median DC dendrite length (42.3 vs. 14.7 µm/cell, P < 0.001). Increased AK severity was correlated with an increase in cyst density, DC size, and dendrite length (all P < 0.05). An increase in cyst density was significantly correlated with an increase in DC density (β = 0.484, P = 0.026) and DC size (β = 0.557, P = 0.009). Conclusions Cyst density and depth of infiltration as well as maturity of the surrounding DC increased significantly with the severity of AK. Translational Relevance Quantitative analysis of cyst density and DC maturity may provide a new method of evaluating the severity of AK.
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Affiliation(s)
- Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Christophe Baudouin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.,Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Antoine Labbé
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.,Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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19
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Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology 2021; 128:1561-1579. [PMID: 33961969 DOI: 10.1016/j.ophtha.2021.04.032] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathologic features in later life. The article analyzes whether the potential benefits of slowing myopia progression by 1 diopter (D) justify the potential risks associated with treatments. METHODS First, the known risks associated with various methods of myopia control are summarized, with emphasis on contact lens wear. Based on available data, the risk of visual impairment and predicted years of visual impairment are estimated for a range of incidence levels. Next, the increased risk of potentially sight-threatening conditions associated with different levels of myopia are reviewed. Finally, a model of the risk of visual impairment as a function of myopia level is developed, and the years of visual impairment associated with various levels of myopia and the years of visual impairment that could be prevented with achievable levels of myopia control are estimated. RESULTS Assuming an incidence of microbial keratitis between 1 and 25 per 10 000 patient-years and that 15% of cases result in vision loss leads to the conclusion that between 38 and 945 patients need to be exposed to 5 years of wear to produce 5 years of vision loss. Each additional 1 D of myopia is associated with a 58%, 20%, 21%, and 30% increase in the risk of myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment, respectively. The predicted mean years of visual impairment ranges from 4.42 in a person with myopia of -3 D to 9.56 in a person with myopia of -8 D, and a 1-D reduction would lower these by 0.74 and 1.21 years, respectively. CONCLUSIONS The potential benefits of myopia control outweigh the risks: the number needed to treat to prevent 5 years of visual impairment is between 4.1 and 6.8, whereas fewer than 1 in 38 will experience a loss of vision as a result of myopia control.
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Affiliation(s)
| | - Eric R Ritchey
- College of Optometry, University of Houston, Houston, Texas
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom; Ophthalmic and Vision Sciences Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Nicolas Leveziel
- Service d'ophtalmologie, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France; University of Poitiers, Poitiers, France; Centre d'Investigation Clinique (CIC 1402), Poitiers, France; Institut National de la Santé et de la Recherche Médicale (INSERM 1084), Poitiers, France; Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rupert R A Bourne
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom; Department of Ophthalmology, Cambridge University Hospital, Cambridge, United Kingdom
| | - D Ian Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland; Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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20
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Lindsay RG, Watters G, Johnson R, Ormonde SE, Snibson GR. Acanthamoeba keratitis and contact lens wear. Clin Exp Optom 2021; 90:351-60. [PMID: 17697181 DOI: 10.1111/j.1444-0938.2007.00172.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acanthamoeba keratitis is a rare but serious complication of contact lens wear that may cause severe visual loss. The clinical picture is usually characterised by severe pain, sometimes disproportionate to the signs, with an early superficial keratitis that is often misdiagnosed as herpes simplex virus (HSV) keratitis. Advanced stages of the infection are usually characterised by central corneal epithelial loss and marked stromal opacification with subsequent loss of vision. In this paper, six cases of contact lens-related Acanthamoeba keratitis that occurred in Australia and New Zealand over a three-year period are described. Three of the patients were disposable soft lens wearers, two were hybrid lens wearers and one was a rigid gas permeable lens wearer. For all six cases, the risk factors for Acanthamoeba keratitis were contact lens wear with inappropriate or ineffective lens maintenance and exposure of the contact lenses to tap or other sources of water. All six patients responded well to medical therapy that involved topical use of appropriate therapeutic agents, most commonly polyhexamethylene biguanide and propamidine isethionate, although two of the patients also subsequently underwent deep lamellar keratoplasty due to residual corneal surface irregularity and stromal scarring. Despite the significant advances that have been made in the medical therapy of Acanthamoeba keratitis over the past 10 years, prevention remains the best treatment and patients who wear contact lenses must be thoroughly educated about the proper use and care of the lenses. In particular, exposure of the contact lenses to tap water or other sources of water should be avoided.
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Affiliation(s)
- Richard G Lindsay
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia.
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21
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Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR - Orthokeratology. Cont Lens Anterior Eye 2021; 44:240-269. [DOI: 10.1016/j.clae.2021.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
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22
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Wu J, Xie H. Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review. J Int Med Res 2021; 49:3000605211000985. [PMID: 33752507 PMCID: PMC7995463 DOI: 10.1177/03000605211000985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Acanthamoeba keratitis (AK) is a rare but severe ocular infection with a significant risk of vision loss. Contact lens use is the main risk factor for AK. The orthokeratology (OK) lens, a specially designed contact lens, has been used worldwide as an effective method of myopia control. However, the OK lens is associated with an increased risk of Acanthamoeba infection. Many primary practitioners are concerned about this infection because of its relative rarity, the lack of promising therapeutic medications, and the need for referral. We herein report two cases of AK associated with OK lenses, present a systematic review of such cases, and discuss the possible reasons for the higher incidence rate of this infection in patients who wear OK lenses. We combined the clinical knowledge and skills of corneal specialists and lens experts with the sole objective of addressing these OK lens-related AK cases. We found that the most common risk factors were rinsing the lenses or lens cases with tap water. Prompt and accurate diagnosis along with adequate amoebicidal treatment are essential to ensure desirable outcomes for OK lens wearers who develop AK. Appropriate OK lens parameters and regular checkups are also important.
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Affiliation(s)
- Jinfang Wu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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23
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Steele KR, Wagner H, Lai N, Zimmerman AB. Gas-Permeable Contact Lenses and Water Exposure: Practices and Perceptions. Optom Vis Sci 2021; 98:258-265. [PMID: 33771955 DOI: 10.1097/opx.0000000000001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study provides insight into the current recommendations, clinical behaviors, and risk assessments of eye care professionals on the topic of rigid contact lens exposure to tap water. This knowledge may motivate professional organizations to develop initiatives to educate eye care professionals on the dangers of contact lens exposure to water. PURPOSE The purpose of this study was to investigate the practice patterns and risk perceptions of eye care professionals regarding gas-permeable contact lens exposure to tap water. METHODS A branched-logic survey was started by 320 clinicians, vision scientists, and industry personnel and was fully completed by 272 participants. The survey queried participants about their current practices, recommendations, and perceptions of risk regarding exposure of gas-permeable contact lenses to tap water. RESULTS Of those who prescribe gas-permeable contact lenses, 57.4% reported rinsing lenses with tap water, whereas only 32.7% reported engaging in this same behavior in front of patients. Of those who reported never rinsing lenses with tap water, 85.6% indicated that rinsing lenses with water increases infection risk, whereas 52.1% of those who rinse lenses with water reported the same perceived risk (P < .001). Of all participants, 60% indicated that wearing contact lenses while showering increases infection risk, and 50.2% of all participants advised patients to avoid this behavior. CONCLUSIONS A discrepancy exists between perceptions of risk concerning exposure of contact lenses to water and both clinical practices and patient education provided by professionals.
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Affiliation(s)
| | - Heidi Wagner
- The Ohio State University, College of Optometry, Columbus, Ohio
| | - Nicky Lai
- The Ohio State University, College of Optometry, Columbus, Ohio
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24
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Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School (D.S.J.), Boston, MA; and Department of Ophthalmology, University of Pittsburgh School of Medicine (V.J.), Pittsburgh, PA
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25
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Gao C, Wan S, Zhang Y, Han J. The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis. Eye Contact Lens 2021; 47:98-103. [PMID: 33060414 DOI: 10.1097/icl.0000000000000746] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Previous studies have found that atropine can slow axial elongation and control the progression of myopia. Some ongoing trials have applied atropine combined with orthokeratology for myopia control, but few studies explored the effect of the strategy on axial elongation. This meta-analysis made a preliminary evaluation of the effect of atropine combined with orthokeratology on axial elongation to provide a reference for further researches. METHODS We performed a specific search on PubMed, EMBASE, Cochrane library, Web of Science, Ovid and Chinese electronic databases of VIP and Wanfang for randomized controlled trials, cohort studies and case-control studies conducted up to December 2019. The weighted mean difference (WMD) of mean change in axial elongation between the combination group of atropine and orthokeratology and the orthokeratology group was used for evaluation. Publication bias was detected using the Funnel plots test. RESULTS A total of five studies involving 341 participants younger than 18 years old met our inclusion criteria. The axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group (0.25 vs. 0.35; WMD=-0.09 mm, [95% confidence intervals, -0.15 to -0.04], Z=3.39, P=0.0007). CONCLUSIONS This meta-analysis demonstrates atropine combined with orthokeratology is effective in slowing axial elongation in myopia children. This effect may be superior to that of the orthokeratology alone.
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Affiliation(s)
- Canran Gao
- School of Clinical Medicine (C.G., S.W., Y.Z.), Capital Medical University, Beijing, China ; and Department of Ophthalmology (J.H.), Tangdu Hospital, the Air Force Medical University, Xi'an, Shaanxi, China
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26
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Chen Z, Jiang J, Xu J, Yang X, Yang Y, Wang K, Song H, Yang B, Cho P. Antibiotic eye drops prescription patterns by orthokeratology practitioners in China and the development of antibiotic usage guidelines. Cont Lens Anterior Eye 2020; 44:101354. [PMID: 32798156 DOI: 10.1016/j.clae.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate antibiotic eye drops prescribing patterns of contact lens practitioners in Mainland China for orthokeratology (ortho-k) patients and to develop guidelines for their use. METHODS A questionnaire on their antibiotic prescribing habits was administered to eye care practitioners (ECP) involved in ortho-k lens fitting nationwide via an official online account. Multiple logistic regression models were used to assess the relationships between prescribing habits and demographics. RESULTS A total of 555 ECP completed the survey, of whom 50.5 % were optometrists (non-medical degree). About 30 % of the respondents routinely prescribed antibiotic eye drops for prophylactic use before and/or after commencement of ortho-k treatment. Forty one percent of the respondents dispensed antibiotics to patients for emergency use without giving written instructions, 48.5 % used antibiotic eye drops to wet fluorescein strips during ortho-k lens fitting, and 44.9 % considered treating corneal infiltrate(s) with antibiotics to be appropriate. A set of guidelines, including when to use antibiotic eye drops during ortho-k lens treatment and their proper use, stratified by different corneal conditions, was developed. CONCLUSIONS Inappropriate use of antibiotic eye drops appeared to be common among ortho-k practitioners in Mainland China. Taking into account deficiencies and errors identified from the survey, a set of guidelines based on best practice was developed and can serve to provide advice for proper use of antibiotics in ortho-k practice.
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Affiliation(s)
- Zhi Chen
- Department of Ophthalmology and Vision Science, Fudan University Eye and ENT Hospital, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, China.
| | - Jun Jiang
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingjing Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Yin Yang
- Department of Ophthalmology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Medical College, University of Electronic Science and Technology, Chengdu, China
| | - Kai Wang
- Department of Ophthalmology, Peking University People's Hospital, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Hongxin Song
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, National Engineering Research Center for Ophthalmology, Beijing, China
| | - Bi Yang
- Department of Optometry and Visual Science, West China School of Medicine, Sichuan University, Chengdu, China
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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Sánchez-González JM, De-Hita-Cantalejo C, Baustita-Llamas MJ, Sánchez-González MC, Capote-Puente R. The Combined Effect of Low-dose Atropine with Orthokeratology in Pediatric Myopia Control: Review of the Current Treatment Status for Myopia. J Clin Med 2020; 9:E2371. [PMID: 32722266 PMCID: PMC7465046 DOI: 10.3390/jcm9082371] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
Pediatric myopia has become a major international public health concern. The prevalence of myopia has undergone a significant increase worldwide. The purpose of this review of the current literature was to evaluate the peer-reviewed scientific literature on the efficacy and safety of low-dose atropine treatment combined with overnight orthokeratology for myopia control. A search was conducted in Pubmed and Web of Science with the following search strategy: (atropine OR low-dose atropine OR 0.01% atropine) AND (orthokeratology OR ortho-k) AND (myopia control OR myopia progression). All included studies improved myopia control by the synergistic effect of orthokeratology with low-dose atropine, compared with orthokeratology treatment alone. All studies included a short or medium follow-up period; therefore longer-term studies are necessary to validate these results.
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Affiliation(s)
- José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (M.-J.B.-L.); (M.C.S.-G.); (R.C.-P.)
- Department of Ophthalmology & Optometry, Tecnolaser Clinic Vision, 41018 Seville, Spain
| | - Concepción De-Hita-Cantalejo
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (M.-J.B.-L.); (M.C.S.-G.); (R.C.-P.)
| | - María-José Baustita-Llamas
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (M.-J.B.-L.); (M.C.S.-G.); (R.C.-P.)
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (M.-J.B.-L.); (M.C.S.-G.); (R.C.-P.)
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (M.-J.B.-L.); (M.C.S.-G.); (R.C.-P.)
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Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt 2020; 40:254-270. [DOI: 10.1111/opo.12686] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
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Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye 2020; 43:322-332. [PMID: 32331970 DOI: 10.1016/j.clae.2020.03.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Abstract
Overnight orthokeratology lenses are approved in countries all over the world for the temporary reduction in myopia, and recently, one lens design has received regulatory approval for myopia control in Europe. The modern orthokeratology lens has a substantial history from its origins of attempting to flatten the corneal curvature with a spherical rigid contact lens to sophisticated gas permeable lenses, designed to reshape the cornea. These lenses are predominantly prescribed for children to slow myopia progression and limit axial elongation of the eye. This article reviews the peer-reviewed literature on the efficacy of orthokeratology for myopia control, sustainability after treatment is discontinued, and the safety concerns of overnight contact lens wear. Future avenues of research are discussed.
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Affiliation(s)
- Mark A Bullimore
- University of Houston, College of Optometry, 4901 Calhoun Rd., Houston, TX, 77204, United States.
| | - Leah A Johnson
- University of Houston, College of Optometry, 4901 Calhoun Rd., Houston, TX, 77204, United States; Paragon Vision Sciences, 2120 West Guadalupe Road, Suite 112, Gilbert, AZ, 85233, United States.
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Singh K, Bhattacharyya M, Goel A, Arora R, Gotmare N, Aggarwal H. Orthokeratology in Moderate Myopia: A Study of Predictability and Safety. J Ophthalmic Vis Res 2020; 15:210-217. [PMID: 32308956 PMCID: PMC7151515 DOI: 10.18502/jovr.v15i2.6739] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/16/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Literature is relatively silent on safety profile and predictability of orthokeratology lenses in terms of myopia correction and prevention of further progression, especially in semi-tropical countries; this study was designed to fill this gap. Methods This prospective, intervention case series enrolled 30 eyes of 30 patients with myopia up to –5.5 diopters (D). Patients were randomized into two groups of 15 each; the study group was prescribed overnight orthokeratology (OK) lenses, while the control group used daily wear conventional soft contact lenses. Follow-up examinations were performed after 1 h and 6 h, and then at 1, 7, 15, 30 days, and 4 months post lens wear. Uncorrected visual acuity (UCVA), contrast sensitivity, keratometry, central corneal thickness (CCT), and tear film break up time (TBUT) were evaluated at each follow-up examination. Results All patients attained a visual acuity of 0.00 Logarithm of the Minimum Angle of Resolution (logMAR) after one week of lens use, which was maintained throughout the study period. While patients allotted to the study group had a gain of 8.1 Snellen lines (UCVA), those in the control group gained 8.9 lines (BCVA) at the end of follow-up period. In the OK group, cornea showed a flattening of 0.8 D (mean keratometry) after single overnight usage of OK lens and overall flattening of 1.2 D compared to baseline, at the end of four months. The change in contrast sensitivity, corneal endothelial specular count, axial length and tear film status was not significant in either group. Conclusion Orthokeratology is an effective and safe modality to correct moderate myopia in motivated young adults. No side effects were encountered after a short-term follow-up in participants who resided in semi-tropical environments.
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Affiliation(s)
- Kirti Singh
- Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi, India
| | | | - Abhishek Goel
- Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi, India
| | - Ritu Arora
- Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi, India
| | - Nikhil Gotmare
- Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi, India
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Ung L, Bispo PJM, Shanbhag SS, Gilmore MS, Chodosh J. The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 2019; 64:255-271. [PMID: 30590103 PMCID: PMC7021355 DOI: 10.1016/j.survophthal.2018.12.003] [Citation(s) in RCA: 333] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 01/16/2023]
Abstract
Microbial keratitis is a potentially blinding condition that must be treated emergently to preserve vision. Although long recognized as a significant cause of corneal blindness, our understanding of its true global scale, associated burden of disease, and etiological patterns remains somewhat limited. Current epidemiological data suggest that microbial keratitis may be epidemic in parts of the world-particularly within South, South-East, and East Asia-and may exceed 2 million cases per year worldwide. Etiological patterns vary between economically developed and developing countries, with bacterial predominance in the former and fungal predominance in the latter. The key to effective management lies in timely diagnosis; however, the current gold standard of stain and culture remains time consuming and often yields no clinically useful results. For this reason, there are attempts to develop highly sensitive and accurate molecular diagnostic tools to provide rapid diagnosis, inform treatment decision making, and minimize the threat of antimicrobial resistance. We provide an overview of these key areas and of avenues for further research toward the goal of more effectively addressing the problem of microbial keratitis on both an individual and public health level.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J M Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India
| | - Michael S Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Current State and Future Trends: A Citation Network Analysis of the Orthokeratology Field. J Ophthalmol 2019; 2019:6964043. [PMID: 30956815 PMCID: PMC6431452 DOI: 10.1155/2019/6964043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/21/2018] [Accepted: 02/12/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Citation network analysis is a powerful tool that allows for a visual and objective representation of the past, present, and potential future directions of a research field. The objective of this study is using citation analysis network to analyse the evolution of knowledge in the field of orthokeratology. Materials and Methods The database used in this citation networks analysis study was Scopus. The descriptor used was “orthokeratology” limited to three fields: title, keywords, and/or abstract, analysing the five most cited authors. Only articles cited at least twenty times were used. The computer software used was UCINET with two types of analysis, qualitative and quantitative. Results 27 nodes have been included according to the search and inclusion criteria. In qualitative analysis, based on illustrate results, the relationships among nodes and their positions and connections show how the study of Cho et al. in 2005 is clearly positioned as a central cutoff point in the network. Quantitative analysis reveals the normalized value of the sample and shows how the study of Cho et al. in 2005 presents the highest percentage of input connections. Conclusions This study shows the state of the flow of information in the orthokeratology field by providing links in bibliographic citations from a qualitative and quantitative point of view.
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Srinivasarao DA, Lohiya G, Katti DS. Fundamentals, challenges, and nanomedicine‐based solutions for ocular diseases. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2018; 11:e1548. [DOI: 10.1002/wnan.1548] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/21/2018] [Accepted: 10/28/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Dadi A. Srinivasarao
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
| | - Garima Lohiya
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
| | - Dhirendra S. Katti
- Department of Biological Sciences and Bioengineering Indian Institute of Technology Kanpur Kanpur India
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Cho P, Tan Q. Myopia and orthokeratology for myopia control. Clin Exp Optom 2018; 102:364-377. [PMID: 30380591 DOI: 10.1111/cxo.12839] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of myopia in children is increasing worldwide and is viewed as a major public health concern. This increase has driven interest in research into myopia prevention and control in children. Although there is still uncertainty in the risk factors underlying differences in myopia prevalence between ethnic groups, rates in children of East Asian descent are typically higher regardless of where they live. Mounting evidence also suggests that myopia prevalence in children increases with age. Earlier commencement and more rigorous education systems in these countries, resulting in more time spent on near-work activities and less time on outdoor activities, may be responsible for the earlier age of myopia onset. However, to date, the mechanisms regulating myopia onset and progression are still poorly understood. Findings from several studies have shown orthokeratology to be effective in slowing axial elongation and it is a well-accepted treatment, particularly in East Asian regions. While our understanding of this treatment has increased in the last decade, more work is required to answer questions, including: How long should the treatment be continued? Is there a rebound effect? Should the amount of myopia control be increased? To whom and when should the treatment be offered? Practitioners are now faced with the need to carefully guide and advise parents on whether and when to undertake a long somewhat complex intervention, which is costly, both in time and money. In the near future, a greater demand for effective prophylaxis against childhood myopia is envisaged. Other than orthokeratology, atropine therapy has been shown to be effective in slowing myopia progression. While its mechanism of control is also not fully understood, it is likely that it acts via a different mechanism from orthokeratology. Thus, a combined treatment of orthokeratology and atropine may have great potential to maximise the effectiveness of myopia control interventions.
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Affiliation(s)
- Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Abstract
OBJECTIVES To investigate the level of compliance with orthokeratology (ortho-k) guidelines and the main behaviors of poor compliance to guide clinical care. METHODS A questionnaire was sent to ortho-k patients in the Eye Hospital of Wenzhou Medical University (EHWMU) in Mainland China who were prescribed ortho-k lenses after January 2013 and have worn ortho-k lenses for more than 1 year to determine the compliance rate for eight wear and care behaviors. Follow-up visit compliance was then investigated among these patients using a retrospective survey. RESULTS A total of 1,500 questionnaires were distributed, and 405 patients responded. The mean age of the patients was 13.1±3.9 years (range 9-22 years); 60.5% of the patients were female, and 98.3% were younger than 18 years. The full compliance rate was 14.1%, the compliance rate for wear and care behaviors was 18.5%, and the compliance rate for follow-up visits was 63.3%. The three highest noncompliance categories for wear and care behaviors were exposure to nonsterile solution, not removing lens depositions according to the eye care practitioners' (ECPs) recommendations and inadequate hand washing. No correlation was observed between the compliance for wear and care behaviors and age, sex, and wearing experience. The follow-up visit compliance rate significantly decreased from the third month to the ninth month. The common reasons for discontinuing follow-up were lack of time, no symptoms, and inconvenience. CONCLUSIONS The level of compliance with ortho-k lens wear in Mainland China is not high, necessitating ECPs to stress to patients the details of wear and care behaviors, especially avoiding exposing lenses to nonsterile solution. Improving monitoring of follow-up visits, particularly within the first 9 months of wearing ortho-k lenses, is needed.
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Bregman J, Jeng BH. Microbial Keratitis Secondary to Therapeutic Contact Lens Wear. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0177-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and knowledge regarding exposure of lenses to water. METHODS The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions. RESULTS GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P < 0.001; storing: 33% GP, 15% SCL P < 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P < 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P < 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P < 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P < 0.0001) and GP lens wearers (P < 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses. CONCLUSIONS Despite previously published evidence of Acanthamoeba keratitis' association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.
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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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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Sticca MP, Carrijo-Carvalho LC, Silva IMB, Vieira LA, Souza LB, Junior RB, Carvalho FRS, Freitas D. Acanthamoeba keratitis in patients wearing scleral contact lenses. Cont Lens Anterior Eye 2017; 41:307-310. [PMID: 29221710 DOI: 10.1016/j.clae.2017.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/17/2017] [Accepted: 12/01/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE To report a series of cases of Acanthamoeba keratitis (AK) in scleral lens wearers with keratoconus to determine whether this type of contact lens presents a greater risk for development of infection. METHODS This study reports three patients who wore scleral contact lenses to correct keratoconus and developed AK. The diagnoses of AK were established based on cultures of the cornea, scleral contact lenses, and contact lens paraphernalia. This study investigated the risk factors for infections. RESULTS The possible risks for AK in scleral contact lens wearers are hypoxic changes in the corneal epithelium because of the large diameter and minimal tear exchange, use of large amounts of saline solution necessary for scleral lens fitting, storing the scleral lens overnight in saline solution rather than contact lens multipurpose solutions, not rubbing the contact lens during cleaning, and the space between the cornea and the back surface of the scleral lens that might serve as a fluid reservoir and environment for Acanthamoeba multiplication. Two patients responded well to medical treatment of AK; one is still being treated. CONCLUSIONS The recommendations for use and care of scleral contact lenses should be emphasized, especially regarding use of sterile saline (preferably single use), attention to rubbing the lens during cleaning, cleaning of the plunger, and overnight storage in fresh contact lens multipurpose solutions without topping off the lens solution in the case.
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Affiliation(s)
- Matheus Porto Sticca
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Linda C Carrijo-Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Isa M B Silva
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Luiz A Vieira
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Luciene B Souza
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Rubens Belfort Junior
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Fábio Ramos S Carvalho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil
| | - Denise Freitas
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil, Brazil.
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Carnt N, Samarawickrama C, White A, Stapleton F. The diagnosis and management of contact lens-related microbial keratitis. Clin Exp Optom 2017; 100:482-493. [PMID: 28815736 DOI: 10.1111/cxo.12581] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 01/10/2023] Open
Abstract
Contact lens-associated microbial keratitis poses a diagnostic dilemma for optometrists on two fronts. The distinction between sterile inflammation and microbial infection is often blurred. In addition, there is a requirement with nearly 50 per cent of the Australian and New Zealand optometric profession being therapeutically endorsed, to distinguish between cases of infection that can be managed in the community verses those that require escalation to public hospitals that have access to laboratory diagnostic tools and advanced imaging techniques, such as in vivo confocal microscopy. Pattern recognition and incorporation of knowledge of aetiology and risk factors assists optometrists to decide on optimal management strategies. Skilled optometrists will utilise emerging diagnostic and therapeutic technologies to ensure safe management strategies and better outcomes for these cases.
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Affiliation(s)
- Nicole Carnt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Chameen Samarawickrama
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew White
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Fang PC, Lo J, Chang TC, Chien CC, Hsiao CC, Tseng SL, Lai YH, Kuo MT. Bacterial Bioburden Decrease in Orthokeratology Lens Storage Cases After Forewarning: Assessment by the DNA Dot Hybridization Assay. Eye Contact Lens 2017; 43:174-180. [PMID: 26859742 PMCID: PMC5405777 DOI: 10.1097/icl.0000000000000252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to measure the changes in the bacterial bioburden in orthokeratology (OK) lens storage cases using the DNA dot hybridization assay (DHA) after forewarning patients about their bacterial contamination severity. METHODS Thirty-one OK lens wearers were prospectively enrolled in this study. Dot hybridization assay was used for serial measurements of bacterial bioburden in OK storage cases after lenses had been soaked for approximately 6 hr. After the first assessment, the lens wearers were informed of the extent of case contamination and the possible risk of microbial keratitis (MK), and best practices for lens care and lens case hygiene were reviewed and reinforced. A second assessment by the same DHA method was performed after approximately 6 months. RESULTS Two universal bacterial probes confirmed a significant decrease in bacterial bioburden at the second assessment (P<0.01 and P<0.001). Genus-specific probes showed significant reductions in Acinetobacter and Klebsiella (P=0.02 and P=0.01), but not in Pseudomonas (P=0.42). CONCLUSIONS Making OK lens wearers aware of the bacterial bioburden in their lens cases resulted in improved quality of case care and reduced bioburden. Our results suggest that a strategy of bioburden assessment with forewarning could be a useful method to decrease the incidence of OK-related MK.
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Affiliation(s)
- Po-Chiung Fang
- Department of Ophthalmology (P.-C.F., J.L., S.-L.T., Y.-H.L., M.-T.K.), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology (T.C.C.), College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Laboratory Medicine (C.-C.C.), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences (C.-C.H.), Chang Gung University and Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Abstract
Efforts to reduce the progression of myopia in childhood are on the rise, due to an increasing incidence of myopia worldwide and its associated sight-threatening complications. Interventions are aimed at reducing myopia in childhood and include environmental considerations, spectacles, contact lenses, and pharmacological agents. We reviewed recent literature with interventions aimed at reducing myopia progression in children and found that a number of interventions were significant in reducing the progression of myopia. Of these interventions, atropine showed the largest dose-related effect on myopia progression control. Although higher doses are associated with side effects of pupil dilatation, loss of accommodation, near vision blur, and rebound phenomenon, low-dose atropine has also been shown to provide effective myopia control with minimal side effects and rebound. To a lesser degree, bifocal soft contact lenses have also been shown to be effective in reducing the progression of myopia, though compliance is an issue. Similarly, orthokeratology lenses have also been shown to be effective in reducing axial length elongation and myopia progression, though long-term data on its rebound effects are unavailable.
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Affiliation(s)
- Su Ann Tay
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore
| | - Sonal Farzavandi
- a Singapore National Eye Centre , Singapore.,b Singapore Eye Research Institute , Singapore
| | - Donald Tan
- a Singapore National Eye Centre , Singapore.,c Department of Ophthalmology , National University of Singapore , Singapore.,d Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School , Singapore
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Abstract
Myopia is not a simple refractive error, but an eyesight-threatening disease. There is a high prevalence of myopia, 80% to 90%, in young adults in East Asia; myopia has become the leading cause of blindness in this area. As the myopic population increases globally, the severity of its impact is predicted. Approximately one fifth of the myopic population has high myopia (≥-6 diopters), which results in irreversible vision loss such as retinal detachment, choroidal neovascularization, cataracts, glaucoma, and macular atrophy. The increasing prevalence of school myopia in the past few decades may be a result of gene-environment interactions. However, earlier school myopia onset would accompany faster myopia progression and greater risk of high myopia later in life. Recently, there have been effective interventions to delay the onset of myopia, such as outdoor activity and decreasing the duration of near work. Hyperopia (≤0.5 diopters) is a predictor of myopia. Pharmacological agents and optic interventions such as low-concentration atropine and orthokeratology may slow progression in myopic children. Novel surgeries and anti-vascular endothelial growth factor drugs could deal with some myopic complications. From available evidence, the prevention, control, and treatment of myopia seem to be promising. However, to reduce the impact of myopia in future decades, more work and effort are still needed, including that by governments and intercountry eye health organizations.
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Affiliation(s)
- Pei-Chang Wu
- From the Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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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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Lee KW, Jung JW. Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.4.546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kang Won Lee
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Ji Won Jung
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
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Efficacy and Acceptability of Orthokeratology for Slowing Myopic Progression in Children: A Systematic Review and Meta-Analysis. J Ophthalmol 2015. [PMID: 26221539 PMCID: PMC4475749 DOI: 10.1155/2015/360806] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background. To evaluate the efficacy and acceptability of orthokeratology for slowing myopic progression in children with a well conducted evidence-based analysis. Design. Meta-analysis. Participants. Children from previously reported comparative studies were treated by orthokeratology versus control. Methods. A systematic literature retrieval was conducted in MEDLINE, EMBASE, Cochrane Library, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The included studies were subjected to meta-analysis using Stata version 10.1. Main Outcome Measures. Axial length change (efficacy) and dropout rates (acceptability) during 2-year follow-up. Results. Eight studies involving 769 subjects were included. At 2-year follow-up, a statistically significant difference was observed in axial length change between the orthokeratology and control groups, with a weighted mean difference (WMD) of -0.25 mm (95% CI, -0.30 to -0.21). The pooled myopic control rate declined with time, with 55, 51, 51, and 41% obtained after 6, 12, 18, and 24 months of treatment, respectively. No statistically significant difference was obtained for dropout rates between the orthokeratology and control groups at 2-year follow-up (OR, 0.79; 95% CI, 0.52 to 1.22). Conclusions. Orthokeratology is effective and acceptable for slowing myopic progression in children with careful education and monitoring.
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Abstract
BACKGROUND Acanthamoeba are microscopic, free-living, single-celled organisms which can infect the eye and lead to Acanthamoeba keratitis (AK). AK can result in loss of vision in the infected eye or loss of eye itself; however, there are no formal guidelines or standards of care for the treatment of AK. OBJECTIVES To evaluate the relative effectiveness and safety of medical therapy for the treatment of AK. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), PubMed (1948 to January 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to January 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 9 January 2015. SELECTION CRITERIA We included randomized controlled trials (RCTs) of medical therapy for AK, regardless of the participants' age, sex, or etiology of disease. We included studies that compared either anti-amoeba therapy (drugs used alone or in combination with other medical therapies) with no anti-amoeba therapy or one anti-amoeba therapy with another anti-amoeba therapy. DATA COLLECTION AND ANALYSIS Two authors independently screened search results and full-text reports, assessed risk of bias, and abstracted data. We used standard methodological procedures as set forth by the Cochrane Collaboration. MAIN RESULTS We included one RCT (56 eyes of 55 participants) in this review. The study compared two types of topical biguanides for the treatment of AK: chlorhexidine 0.02% and polyhexamethylene biguanide (PHMB) 0.02%. All participants were contact lens wearers with a median age of 31 years. Treatment duration ranged from 51 to 145 days. The study, conducted in the UK, was well-designed and had low risk of bias overall.Outcome data were available for 51 (91%) of 56 eyes. Follow-up times for outcome measurements in the study were not reported. Resolution of infection, defined as control of ocular inflammation, relief of pain and photosensitivity, and recovery of vision, was 86% in the chlorhexidine group compared with 78% in the PHMB group (relative risk (RR) 1.10, 95% confidence intervals (CI) 0.84 to 1.42). In the chlorhexidine group, 20 of 28 eyes (71%) had better visual acuity compared with 13 of 23 eyes (57%) in the PHMB group at final follow-up (RR 1.26, 95% CI 0.82 to 1.94). Five participants required therapeutic keratoplasty: 2 in the chlorhexidine group compared with 3 in the PHMB group (RR 0.55, 95% CI 0.10 to 3.00). No serious adverse event related to drug toxicity was observed in the study. AUTHORS' CONCLUSIONS There is insufficient evidence to evaluate the relative effectiveness and safety of medical therapy for the treatment of AK. Results from the one included study yielded no difference with respect to outcomes reported between chlorhexidine and PHMB. However, the sample size was inadequate to detect clinically meaningful differences between the two groups as indicated by the wide confidence intervals of effect estimates.
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Affiliation(s)
- Majed Alkharashi
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia.
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Chan TCY, Li EYM, Wong VWY, Jhanji V. Orthokeratology-associated infectious keratitis in a tertiary care eye hospital in Hong Kong. Am J Ophthalmol 2014; 158:1130-1135.e2. [PMID: 25158307 DOI: 10.1016/j.ajo.2014.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. DESIGN Retrospective study. METHODS Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes. RESULTS A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9-23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6-131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P < .001). CONCLUSIONS Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes.
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Affiliation(s)
- Tommy C Y Chan
- Hong Kong Eye Hospital, Hong Kong SAR, China; and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Emmy Y M Li
- Hong Kong Eye Hospital, Hong Kong SAR, China; and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Victoria W Y Wong
- Hong Kong Eye Hospital, Hong Kong SAR, China; and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vishal Jhanji
- Hong Kong Eye Hospital, Hong Kong SAR, China; and Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
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