Nidek OPD-scan analysis of normal, keratoconic, and penetrating keratoplasty eyes

PURPOSE: To determine by wavefront analysis the difference between eyes considered normal, eyes diagnosed with keratoconus, and eyes that have undergone penetrating keratoplasty METHODS: The Nidek OPD-Scan wavefront aberrometer was used to measure ocular aberrations out to the sixth Zernike order. One hundred and thirty eyes that were free of ocular pathology, 41 eyes diagnosed with keratoconus, and 8 eyes that had undergone penetrating keratoplasty were compared for differences in root mean square value. Three and five millimeter root mean square values of the refractive power aberrometry maps of the three classes of eyes were compared. Radially symmetric and irregular higher order aberration values were compared for differences in magnitude. RESULTS: Root mean square values were lower in eyes free of ocular pathology compared to eyes with keratoconus and eyes that had undergone penetrating keratoplasty. The aberrations were larger with the 5-mm pupil. Coma and spherical aberration values were lower in normal eyes. CONCLUSION: Wavefront aberrometry of normal, pathological, and eyes after surgery may help to explain the visual distortions encountered by patients. The ability to measure highly aberrated eyes allows an objective assessment of the optical consequences of ocular pathology and surgery. The Nidek OPD-Scan can be used in areas other than refractive surgery.

Keratoconus:a review

Keratoconus is the most common primary ectasia. It usually occurs in the second decade of life and affects both genders and all ethnicities. The estimated prevalence in the general population is 54 per 100,000. Ocular signs and symptoms vary depending on disease severity. Early forms normally go unnoticed unless corneal topography is performed. Disease progression is manifested with a loss of visual acuity which cannot be compensated for with spectacles. Corneal thinning frequently precedes ectasia. In moderate and advance cases, a hemosiderin arc or circle line, known as Fleischer's ring, is frequently seen around the cone base. Vogt's striaes, which are fine vertical lines produced by Descemet's membrane compression, is another characteristic sign. Most patients eventually develop corneal scarring. Munson's sign, a V-shape deformation of the lower eyelid in downward position; Rizzuti's sign, a bright reflection from the nasal area of the limbus when light is directed to the limbus temporal area; and breakages in Descemet's membrane causing acute stromal oedema, known as hydrops, are observed in advanced stages. Classifications based on morphology, disease evolution, ocular signs and index-based systems of keratoconus have been proposed. Theories into the genetic, biomechanical and biochemical causes of keratoconus have been suggested. Management varies depending on disease severity. Incipient cases are managed with spectacles, mild to moderate cases with contact lenses and severe cases can be treated with keratoplasty. This article provides a review on the definition, epidemiology, clinical features, classification, histopathology, aetiology and pathogenesis, and management and treatment strategies for keratoconus.

Fitting an MSD (Mini Scleral Design) rigid contact lens in advanced keratoconus with INTACS

Keratoconus is a bilateral degenerative disease characterized by a non-inflammatory, progressive central corneal ectasia (typically asymmetric) and decreased vision. In its early stages it may be managed with spectacles and soft contact lenses but more commonly it is managed with rigid contact lenses. In advanced stages, when contact lenses can no longer be fit, have become intolerable, or corneal damage is severe, a penetrating keratoplasty is commonly performed. Alternative surgical techniques, such as the use of intra-stromal corneal ring segments (INTACS) have been developed to try and improve the fit of rigid contact lenses in keratoconic patients and avoid penetrating keratoplasties. This case report follows through the fitting of rigid contact lenses in an advanced keratoconic cornea after an INTACS procedure and discusses clinical findings, treatment options, and the use of mini-scleral and scleral lens designs as they relate to the challenges encountered in managing such a patient. Mini-scleral and scleral lenses are relatively easy to fit, and can be of benefit to many patients, including advanced keratoconic patients, post-INTAC patients and post-penetrating keratoplasty patients. © 2011 British Contact Lens Association.