Conjunctival Inlapse: Nasal and Temporal Conjuctival Shape Variations associated with Scleral Lens Wear
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Abstract
PURPOSE: This article aims to report a new clinical finding associated with the wear of scleral lenses.
METHODS: Non-contact lens wearer subjects were recruited and fitted with large diameter (18 mm) scleral lenses. Lens was randomly filled with non preserved saline or non preserved carboxymethylcellulose-based artificial tears (Refresh Celluvisc, Allergan, Ca). The sinking of the lens on the nasal and temporal sclera was assessed periodically during a total of 6h00 of wear, with the use of anterior segment coherence tomography (OCT- Optovue, Clarion Technologies, Texas). Images were taken every 30 minutes for the first 2h00, then at 4h00 and 6h00 post-insertion.
RESULTS: The nasal side sinks significantly more than the temporal side by 23.0±7.3 μm (F(1,12)=10.043; p=0.008; 95%CI:[7.2 ,38.9]). This difference is significant with time (F=8.757; p<0.001) and there is a side effect (F=10.043; p=0.008). The type of solution does not influence the lens behavior (F=0.250; p=0.626). A new clinical finding was revealed during scan analysis. Conjunctival tissue displacement was seen, under the reverse curve of the scleral lens, shortly after insertion. This conjunctival “inlapse” (CI) was sustained over all the wearing hours. On the nasal quadrant, CI was reduced in height and present in only 8/15 subjects while, in the temporal quadrant, 100% of subjects showed an average CI of 38.39 ± 10.43 μm (t(84)=3.68; p=0.0072; 95%CI[17.64, 59.13]) 30 minutes post insertion followed by a non-significant decrease of 1.97 ± 10.34 μm (t(84)=0.19; p=1.00; 95%CI[-22.52,18.58]) between 30 minutes and 6 hours of wear.
CONCLUSION: Nasal sinking is more pronounced as compared with temporal lens sinking. This may explain the occurrence of a new clinical phenomenon identified to happen shortly after lens insertion, under the reverse curve of a scleral lens. In fact, CI happens mostly on the temporal quadrant, where more space is available for the conjunctival tissue to move. This finding suggests that conjunctival tissue reacts to scleral lens wear, not only in the inferior quadrant, where conjunctival prolapse is known to occur, but in every other one as well.
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References
2. Michaud L, Bennett ES, Woo SL, et al. Clinical Evaluation of Large Diameter Rigid-Gas Permeable Versus Soft Toric Contact Lenses for the Correction of Refractive Astigmatism. A MultiCenter Study. Eye Contact Lens. 2016.
3. van der Worp E, Bornman D, Ferreira DL, et al. Modern scleral contact lenses: A review. Cont Lens Anterior Eye. 2014;37(4):240-50.
4. Van der Worp E. A Guide to Scleral Lens Fitting [mono-graph online]. Forest Grove, OR: Pacific University: Pacific University Libraries at CommonKnowledge; 2010. 63 p.
5. De Naeyer G, Sanders D, Van der Worp E, et al. Qualitative Assessment of Scleral Shape Patterns Using a New Wide Field Ocular Surface Elevation Topographer Journal of COntact Lens Research and Science. 2017;1(1):12-22.
6. Subbaraman LN. In Focus with Current Contact Lens Materials And Designs. CL Spectrum. 2017;32(May):22-5.
7. Visser ES, Visser R, Van Lier HJ. Advantages of toric
scleral lenses. Optom Vis Sci. 2006;83(4):233-6.
8. Alonso-Caneiro D, Vincent SJ, Collins MJ. Mor-
phological changes in the conjunctiva, episclera and sclera following short-term miniscleral contact lens wear in rigid lens neophytes. Cont Lens Anterior Eye. 2016;39(1):53-61.
9. Courey C, Michaud L. Variation of clearance consid-ering viscosity of the solution used in the reservoir and following scleral lens wear over time. Cont Lens Anterior Eye. 2017;40(4):260-6.
10. Walker MK, Bergmanson JP, Miller WL, et al. Com-plications and fitting challenges associated with scleral contact lenses: A review. Cont Lens Anterior Eye. 2016;39(2):88-96.
11. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for manag-ing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens. 2005;31(3):130-4.
12. Alipour F, Behrouz MJ, Samet B. Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye. 2015;38(1):54-8.
13. De Grys M, . Thirty Feet and Rising: Constructing and Using a Water Barometer To Explore Chemical Principles. J Chem Educ. 2003;80(10):1156.
14. Stillinger FH. Molecular dynamics study of liquid water under high compression. The Journal of Chemi-cal Physics 1974;61:4973.
15. Romero-Rangel T, Stavrou P, Cotter J, et al. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol 2000;130(1):25-32.
16. Paugh JR, Chen E, Heinrich C, et al. Silicone Hydrogel and Rigid Gas-Permeable Scleral Lens Tear Exchange. Eye Contact Lens. 2018.
17. Miller WL. Managing Scleral Lens-Induced Conjunc-tival Prolapse. CL Spectrum. 2015;30(September):48.
18. Caroline P, Andre M. Scleral lens settling. CL Spec-
trum. 2012;27(May ):56.
19. Severinsky B, Behrman S, Frucht-Pery J, et al. Scleral
contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes. Cont Lens Anterior Eye. 2014;37(3):196-202.