DOCSLIB.ORG

Dgardner Academy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Dgardner Academy Dustin J. Gardner, O.D. In cases of large keratoconus or pellucid marginal degeneration, fitting gas permeable lenses can prove to be difficult and uncomfortable for the patient. Often the use of mini-scleral or scleral lenses is beneficial. I. Case History A forty two year old Caucasian female presented to the clinic for a contact lens fitting for keratoconus OU. Ocular history showed the patient was diagnosed with keratoconus OU 18 years ago, and long-standing vitreal floaters. The patient previously wore gas permeable contact lenses, but discontinued them due to poor fit, and issues with lenses repeatedly falling out. Patient was currently wearing soft toric contact lenses which provided acceptable comfort but poor vision. No history of ocular trauma, surgeries, or other disease was reported. Patient reported no significant medical history. Family medical history revealed hypertension in her father and diabetes mellitus in her mother. The patient reports taking Zoloft (sertraline) and had no known drug allergies. II. Pertinent Findings Patient currently wears soft toric contact lenses of an unknown brand. Distance visual acuity was 20/40-2 OD and 20/30+2 OS. Best corrected visual acuity with manifest refraction was OD -12.75-2.25x082 with 20/50 visual acuity, and OS -10.75-3.25x106 with 20/40+ visual acuity. Slit lamp examination revealed mild inferior central stromal scarring and striae OD, and scarring with associated neovascularization of the inferior cornea adjacent to the limbus OS. Topography results revealed simulated K values of 48.6D/50.4D@7degrees OD and 44.1D/50.8D@164degrees OS. Both corneas had large areas of inferior steepening in a possible “kissing bird” formation OU. Patient was recently seen for a complete eye exam at another practice, and was referred for a contact lens fit only. No dilated fundus exam performed at this visit and no previous exam data was provided. III. Differential Diagnosis, Differential Treatment Differential Diagnosis The differential diagnosis includes keratoconus, pellucid marginal degeneration, and keratoglobus. Keratoconus is the primary diagnosis due to inferior corneal steepening, the physical findings of apical scarring, striae, and clinical finding of high myopia and astigmatism. Pellucid marginal degeneration is a secondary diagnosis. This is supported by topography images revealing a “kissing bird” or “butterfly” like formation of large inferior region of steepening. However it is not a typical classic presentation, and a large inferior cone can sometimes have a similar appearance. Keratoglobus typically presents with diffuse thinning/steepening of the entire cornea and is therefore ruled out by the topography. Differential Treatment Differential treatment for this patient includes spectacle correction, soft toric contact lenses, spherical gas permeable (GP) contact lenses, specialty GP contact lenses for irregular corneas, corneal collagen cross linking, and corneal transplant/graft. The patient currently wears soft toric contact lenses and is experiencing uncorrectable visual blur. The irregular astigmatism, high minus and high astigmatic refractive error is not ideal for a soft toric contact lens fit. These lenses often have rotation and stability issues when fitted over a steep cornea with keratoconus. Also, soft toric contact lenses are unable to correct irregular astigmatism. Spherical GP lenses can often provide great vision for a patient with an emerging cone. The rigid lens allows for optical correction of the irregular refractive corneal surface. This patient reports a previous unsuccessful history of gas permeable wear. This patient’s presentation is too advanced for correction with traditional spherical GP lenses. Corneal collagen cross-linking is used to strengthen the cornea and results in stopping/slowing the progression of keratoconus.1 This is a relatively new procedure with a high cost. Fairly advanced cases may not receive significant benefit from the procedure and therefore was not explored with this patient. Surgical options include complete or partial transplants of the cornea. These are typically reserved for severely advanced cases in which vision is significantly reduced, and uncorrectable due to scarring, and/or is causing the patient pain from corneal hydrops secondary to keratoconus. This patient is not experiencing hydrops and has stable, relatively clear corneas. Specialty GP lenses are made to be steeper, larger, and more customizable than traditional spherical GP lenses, and allow for a more comfortable and stable fit. This treatment method was determined to be the most beneficial. IV. Diagnosis and Discussion This patient has large inferior keratoconus OD and OS. Keratoconus is a non- inflammatory ectasia of the cornea presenting with stromal thinning, typically of the inferior or central two-thirds of the cornea, resulting in a conical protrusion. The condition is nearly always bilateral, but is often asymmetric.2,3,4 The abnormality of the cornea also induces high myopia and irregular astigmatism.2,3 Clinical signs include oil droplet reflex of the cornea (Charleaux’s sign), iron ring deposition in the corneal epithelium (Fleischer’s ring), fine vertical folds of the stroma and Descemet’s membrane (Vogt’s striae), and enlarged corneal nerves.2,3,4 Topography typically reveals a classic inferior-central cone of steepening.4 In more advanced cases it is possible to note a V-shape to the lower lid in downward gaze (Munson’s sign), and illumination from the temporal side of the cornea will become sharply focused near the nasal limbus (Rizzutti’s phenomenon).2,3 A secondary diagnosis of pellucid marginal degeneration (PMD) was made. These conditions are often mistaken for one another due to similar clinical presentation, and management methods. It can be difficult to differentiate the two from each other. There is no clear answer on whether they are in fact two distinct diseases or simply a variation of the same disorder. 4 PMD is also a bilateral, but often asymmetrical, non-inflammatory condition characterized by a one to two millimeter wide band of inferior corneal thinning. This also results in high myopia and against-the-rule astigmatism.4,5,6,7 In advanced cases Munson’s sign, and Rizzzuti’s phenomenon can be noted, adding to the confusion between the two conditions.4 Often topography can be a useful clinical test to provide some distinction. A classic topographical presentation of PMD shows large areas of inferior steepening stretching from the four o’clock to eight o’clock position in a “kissing bird”, “butterfly”, or “crab claw” appearance.4,5,6 However, some studies have indicated that this classic topography is not diagnostic of PMD, and these patterns can be found in cases of keratoconus as well. Diagnosis must be made based upon a combination of slit-lamp findings, topography, and pachymetry maps.4,6 In this case a pachymetry map has not been obtained, therefore a reliable diagnosis cannot be made. V. Treatment, management Clinic Visit 1 Previous attempts made to fit Dyna Z Intralimbal lenses were unsuccessful due to unresolveable bubble formation issues and decreased comfort. Lenses were removed and a Medmont topography was performed. Large areas of inferior corneal steepening in a “kissing bird” formation were found, leaving suspicion of possible pellucid marginal degeneration. It was decided that scleral or mini-scleral lenses would most likely allow for a better fit, comfort, and visual outcome. Diagnostic fit with Jupiter lenses was performed as described by the fitting guide. Selection of base curve begins with slightly steeper than average keratometry or simulated K power. Then steepen or flatten to achieve a tear reservoir of 200-300 microns, which allows for settling of the lens. Once proper central alignment is achieved, analyze the limbal area for 40-50 microns of vaulting and assure the periphery is aligned with the sclera. If blanching is noted flatten the peripheral curve interior to the blanching. Initial lenses selected had a larger diameter of 18.2 mm to allow for more vaulting of the cornea. Base curve selected by adding a half diopter to the average keratometric value of each eye. After insertion of the lenses fluorescein pattern revealed areas of mid-peripheral touch OU. New lenses selected with a one diopter increase in base curve OU. These lenses showed vaulting over the entire cornea and limbus. The right lens presented with a slight mid-peripheral bubble and trace areas of blanching of conjunctiva in the periphery. The base curve of the lens ordered was flattened by 0.50 diopter to reduce bubble formation, and possibly relieve the conjunctival blanching. Spherical over-refractions allowed for a distance visual acuity of 20/20 OD and 20/25+ OS. Accounting for the over-refractions, lenses ordered with parameters of: OD: BC 6.985/OAD 18.2/Power -12.25 OS: BC 6.62/OAD 18.2/Power -15.25 Clinic Visit 4 The patient returned to the clinic for dispense of the ordered Jupiter lenses. After insertion visual acuity was measured to be 20/20 OD and 20/20- OS. The patient also reported significantly improved comfort. After allowing a settling period of one half hour, fluorescein evaluation showed full vaulting of the cornea and limbus, no presence of bubble formation, or blanching of the conjunctiva. Estimated apical clearance based on optic section was 200 microns. An optic section can be used to compare thickness of the lens, which is approximately 250 microns, the cornea, which is approximately 500 microns and the lacrimal lens. This allows for estimation of the vault over the cornea. Insertion and removal training performed. Patient was able to demonstrate proper insertion and removal of both lenses. Patient was educated on proper wear and care of lenses, released, and scheduled back for a two week follow up. Treatment/Management Discussion Treatment and management of corneal ectasia is often based upon how advanced the condition is. A common scale of severity is based on keratometry readings.
Load more

Recommended publications
  • Binocular Vision Disorders  Prescribing Guidelines
    Prescribing for Preverbal Children Valerie M. Kattouf O.D. FAAO, FCOVD Illinois College of Optometry Associate Professor Prescribing for Preverbal Children Issues to consider: Age Visual Function Refractive Error Norms Amblyogenic Risk Factors Birth History Family History Developmental History Emmetropization A process presumed to be operative in producing a greater frequency of occurrence of emmetropia than would be expected in terms of chance distribution, as may be explained by postulating that a mechanism coordinates the formation and the development of the various components of the human eye which contribute to the total refractive power Emmetropization Passive process = nature and genetics 60% chance of myopia if 2 parents myopic (Ciuffrieda) Active process = mediated by blur and visual system compensates for blur Refractive Error Norms Highest rate of emmetropization – 1st 12-17 months Hyperopia Average refractive error in infants = +2 D > 1.50 diopters hyperopia at 5 years old – often remain hyperopic Refractive Error Norms Myopia 25% of infants are myopic Myopic Newborns (Scharf) @ 7 years 54% still myopic @ 7 years 46% emmetropic @ 7 years no hyperopia Refractive Error Norms Astigmatism Against the rule astigmatism more prevalent switches to with-the-rule with development At 3 1/2 years old astigmatism is at adult levels INFANT REFRACTION NORMS AGE SPHERE CYL 0-1mo -0.90+/-3.17 -2.02+/-1.43 2-3mo -0.47+/-2.28 -2.02+/-1.17 4-6mo -0.00+/-1.31 -2.20+/-1.15 6-9mo +0.50+/-0.99 -2.20+/-1.15 9-12mo +0.60+/-1.30 -1.64+/-0.62
    [Show full text]
  • Refractive Error Changes in Cortical, Nuclear and Posterior Subcapsular Cataracts
    1524 Refractive error changes in cortical, nuclear and posterior subcapsular cataracts. D.B. Elliott & K. Pesudovs . Department of Optometry, University of Bradford, Bradford, United Kingdom.. Purpose • To determine the effect of the three main morphological types of age-related cataract on refractive error. Background • The increase in myopia in some patients with age-related nuclear cataract is well known (Brown & Hill, 1987). This change accounts for the “second sight of the elderly” in which the myopic shift provides normal reading ability without the need for spectacles. Distance vision, however, worsens. • Planter (1981) suggested that cortical opacity can induce hyperopic shifts. However, this claim has not been repeated since and no firm evidence is available. • Review papers suggest that cortical opacity can induce astigmatic changes (Brown, 1993). However, these reports were based on clinical impression with no supporting data. • . The prevalence of uncorrected refractive error in the elderly population is high (Wormald et al., 1992). It is likely that a reasonable proportion of these patients have refractive error changes induced by cataract. • It has been suggested that a delay in operating on age-related cataract of 10 years could reduce the number of patients requiring cataract surgery (Kupfer, 1985). The possible role of correcting cataract-induced refractive error to delay the need for surgery should be explored. Subjects • 98 elderly subjects (mean age 67 ± 8 years) were recruited. • 77 subjects had one type of morphological cataract: 34 subjects had cortical cataract, 21 had nuclear cataract and 21 had posterior subcapsular cataract (PSC). • 22 subjects had normal, healthy eyes. • Ocular screening excluded amblyopia, strabismus, eye disease or surgery.
    [Show full text]
  • Fact Sheet: Refractive Errors
    Fact Sheet: Refractive Errors More than 11 million Americans have common vision problems that can be corrected with the use of prescriptive eyewear such as glasses or contact lenses.1 These conditions are known as refractive errors and they occur when the eye doesn’t correctly bend, or ―refract,‖ light as it enters the eye. Common refractive errors include the following: o Nearsightedness (also called myopia)—A condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. o Farsightedness (also called hyperopia)—A common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. o Astigmatism—A condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. o Presbyopia—An age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Refractive errors are one of the most common—and correctable—causes of visual impairment in the United States. According to a recent study led by the National Eye Institute (NEI), approximately half of all American adults don’t have the 20/20 vision physicians consider optimal due to refractive errors.2 Women experience refractive error more frequently than men: Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older.
    [Show full text]
  • Hyperopia Hyperopia
    Hyperopia Hyperopia hyperopia hyperopia • Farsightedness, or hyperopia, • Farsightedness occurs if your eyeball is too as it is medically termed, is a short or the cornea has too little curvature, so vision condition in which distant objects are usually light entering your eye is not focused correctly. seen clearly, but close ones do • Its effect varies greatly, depending on the not come into proper focus. magnitude of hyperopia, the age of the individual, • Approximately 25% of the the status of the accommodative and general population is hyperopic (a person having hyperopia). convergence system, and the demands placed on the visual system. By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson; Flash illustration by Stephen Bagi 1. Cornea is too flap. hyperopia • In theory, hyperopia is the inability to focus and see the close objects clearly, but in practice many young hyperopics can compensate the weakness of their focusing ability by excessive use of the accommodation functions of their eyes. Hyperopia is a refractive error in • But older hyperopics are not as lucky as them. By which parallel rays of light aging, accommodation range diminishes and for 2. Axial is too short. entering the eye reach a focal older hyperopics seeing close objects becomes point behind the plane of the retina, while accommodation an impossible mission. is maintained in a state of relaxation. 1 Amplitude of Accommodation hyperopia Maximum Amplitude= 25-0.4(age) • An emmetropic eye for reading and other near Probable Amplitude= 18.5-.3(age) work, at distance of 16 in (40cm), the required amount of acc.
    [Show full text]
  • Myopia: More Than a Refractive Error − Lasik and Retinal Dystrophies
    MYOPIA: MORE THAN A REFRACTIVE ERROR − LASIK AND RETINAL DYSTROPHIES WALRAEDT S.1*, LEROY B.P.1,2*, KESTELYN P.H.1, DE LAEY J.J.1 SUMMARY SAMENVATTING Three patients who had undergone laser in situ Drie patiënten die een correctie van myopie hadden keratomileusis (LASIK) correction for myopia were ondergaan met laser in situ keratomileusis (LASIK) first seen because of suboptimal visual acuity (VA) werden onderzocht omwille van postoperatieve sub- and night blindness and/or photophobia. After a com- optimale visus en nachtblindheid en/of fotofobie. Na prehensive examination including psychophysical uitgebreid onderzoek met inbegrip van psychofysi- and electrophysiological tests, two of the three pa- sche en electrofysiologische testen werd een dia- tients were shown to suffer from a progressive cone- gnose van progressieve kegeltjes-staafjesdystrofie ge- rod dystrophy. The third patient had retinitis pig- steld bij twee patiënten. De derde patiënt leed aan mentosa. These cases illustrate the need for in depth retinitis pigmentosa. Deze gevallen illustreren de preoperative evaluation in myopic patients about to noodzaak van een doorgedreven preoperatief onder- undergo LASIK when signs or problems of night blind- zoek bij myope patiënten die LASIK zullen onder- ness and/or photophobia are present. gaan met klachten van nachtblindheid en fotofobie. KEY WORDS RÉSUMÉ Retinal dystrophy, cone-rod dystrophy, Trois patients sont présentés ayant été examinés pour retinitis pigmentosa, photophobia, night une acuité visuelle sous-optimale et une héméralo- blindness, laser in situ keratomileusis, pie et/ou photophobie, après correction d’une myo- preoperative evaluation pie suivant la technique du laser in situ keratomi- leusis (LASIK). Sur base d’une évaluation élaborée, MOTS-CLÉS y inclus des tests psychophysiques et éléctrophysio- logiques, un diagnostic de dystrophie des cônes et Dystrophie rétinienne, dystrophie de type bâtonnets a été établi chez deux patients.
    [Show full text]
  • Management Modalities for Keratoconus an Overview of Noninterventional and Interventional Treatments
    REFRACTIVE SURGERY FEATURE STORY EXCLUSIVE ONLINE CONTENT AVAILABLE Management Modalities for Keratoconus An overview of noninterventional and interventional treatments. BY MAZEN M. SINJAB, MD, PHD anagement of keratoconus has advanced TAKE-HOME MESSAGE during the past few years, and surgeons can • When evaluating patients with keratoconus, ask now choose among numerous traditional and them to stop using RGP contact lenses at least 2 modern treatments. Traditional modalities weeks before evaluation to achieve correct Msuch as spectacle correction, contact lenses, penetrating measurement of the corneal shape. keratoplasty (PKP), and conductive keratoplasty (CK) • Interventional management modalities include CK, are still effective; however, demand for the last two has PKP, DALK, ICRSs, CXL, phakic IOLs, or some decreased with the advent of modern alternatives, specifi- combination of these treatments. cally intrastromal corneal ring segments (ICRSs) and cor- • Making the right management decision depends neal collagen crosslinking (CXL). Caution should be used on the patient’s corneal transparency and stress when considering these newer treatment modalities, and lines, age, progression, contact lens tolerance, surgeons should be aware of their indications, contraindi- refractive error, UCVA and BCVA, K-max, corneal cations, conditions, and complications before proceeding thickness, and sex. with treatment. Keratoconus treatments can be divided into two cate- Some patients achieve good vision correction and comfort gories, interventional and noninterventional. In this article, with this strategy. particular attention is given to ICRSs and CXL, as they are Advances in lens designs and materials have increased the the most popular emerging interventional management proportion of keratoconus patients who can be fitted with modalities for keratoconus.
    [Show full text]
  • Cone Contributions to Signals for Accommodation and the Relationship to Refractive Error
    Vision Research 46 (2006) 3079–3089 www.elsevier.com/locate/visres Cone contributions to signals for accommodation and the relationship to refractive error Frances J. Rucker ¤, Philip B. Kruger Schnurmacher Institute for Vision Research, State University of New York, State College of Optometry, 33 West 42nd Street, New York, NY 10036, USA Received 18 February 2005; received in revised form 7 April 2006 Abstract The accommodation response is sensitive to the chromatic properties of the stimulus, a sensitivity presumed to be related to making use of the longitudinal chromatic aberration of the eye to decode the sign of the defocus. Thus, the relative sensitivity to the long- (L) and middle-wavelength (M) cones may inXuence accommodation and may also be related to an individual’s refractive error. Accommodation was measured continuously while subjects viewed a sine wave grating (2.2 c/d) that had diVerent cone contrast ratios. Seven conditions tested loci that form a circle with equal vector length (0.27) at 0, 22.5, 45, 67.5, 90, 120, 145 deg. An eighth condition produced an empty Weld stimulus (CIE (x,y) co-ordinates (0.4554, 0.3835)). Each of the gratings moved at 0.2 Hz sinusoidally between 1.00 D and 3.00 D for 40 s, while the eVects of longitudinal chromatic aberration were neutralized with an achromatizing lens. Both the mean level of accommo- dation and the gain of the accommodative response, to sinusoidal movements of the stimulus, depended on the relative L and M cone sen- sitivity: Individuals more sensitive to L-cone stimulation showed a higher level of accommodation (p D 0.01; F D 12.05; ANOVA) and dynamic gain was higher for gratings with relatively more L-cone contrast.
    [Show full text]
  • Refractive Changes After Scleral Buckling Surgery
    Refractive changes after scleral buckling surgery Alterações refracionais após retinopexia com explante escleral João Jorge Nassaralla Junior1 ABSTRACT Belquiz Rodriguez do Amaral Nassaralla2 Purpose: A prospective study was conducted to compare the refractive changes after three different types of scleral buckling surgery. Methods: A total of 100 eyes of 100 patients were divided into three groups according to the type of performed buckling procedure: Group 1, encircling scleral buckling (42 patients); Group 2, encircling with vitrectomy (30 patients); Group 3, encircling with additional segmental buckling (28 patients). Refractive examinations were performed before and at 1, 3 and 6 months after surgery. Results: Changes in spherical equivalent and axial length were significant in all 3 groups. The amount of induced astigmatism was more significant in Group 3. No statistically significant difference was found in the amount of surgically induced changes between Groups 1 and 2, at any postoperative period. Conclusions: All three types of scleral buckling surgery were found to produce refractive changes. A correlation exists between additional segments and extent of refractive changes. Keywords: Retinal detachment/surgery; Scleral buckling/adverse effects; Refraction/ ocular; Biometry INTRODUCTION During the past several years, our Retina Service and others(1) have continued to use primarily solid implants with encircling bands. Only occa- sionally episcleral silicone rubber sponges are utilized. Changes in refrac- tion are frequent after retinal detachment surgery. The surgical technique used appears to influence these changes. Hyperopia(2) and hyperopic astig- matism may occur presumably by shortening the anteroposterior axis of the globe after scleral resections(1). Scleral buckling procedures employing an encircling band generally are expected to produce an increase in myopia and myopic astigmatism(1,3).
    [Show full text]
  • Analysis of Tear Film Spatial Instability for Pediatric Myopia Under Treatment
    www.nature.com/scientificreports OPEN Analysis of tear flm spatial instability for pediatric myopia under treatment Wan‑Hua Cho, Po‑Chiung Fang, Hun‑Ju Yu, Pei‑Wen Lin, Hsiu‑Mei Huang & Ming‑Tse Kuo * In Taiwan, the prevalence of myopia in children between 6 and 18 years old is over 80%, and high myopia accounts for over 20%, which turned out to be in the leading place worldwide. Orthokeratology and low-dose atropine are proven treatments to reduce myopia progression, though the potential corneal disturbances remain an issue in young populations. The alteration of the tear flm is widely discussed but there is no consensus to date, so we aim to investigate the tear flm spatial instability in children with myopia control using atropine or orthokeratology. Thirty-eight treatment-naïve participants and 126 myopic children under treatments were enrolled. The ocular surface homeostasis, spatial distribution of tear break-up, and high-order aberrations (HOAs) of the corneal surface were assessed. We found out that myopic children treated with either atropine or orthokeratology showed ocular surface homeostasis similar to that in treatment-naïve children. Nevertheless, children treated with orthokeratology presented higher HOAs (p < 0.00001) and a tendency of the frst tear break-up zone at the inner half of the cornea (p = 0.04). This unique spatial instability of the tear flm associated with myopia treatment might provide a more focused way of monitoring the pediatric tear flm instability. Many studies have revealed diferences in the prevalence of myopia across diferent regions and ethnicities, and the increased rate of myopia is most prominent in Asian/Pacifc children1,2.
    [Show full text]
  • Refractive Errors a Closer Look
    2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep.
    [Show full text]
  • Treatment of Pellucid Marginal Degeneration 1Abdelsattar N Farrag, 2Ahmed a Hussein, 3Shiji Ummar
    IJKECD Treatment10.5005/jp-journals-10025-1148 of Pellucid Marginal Degeneration REVIEW ARTICLE Treatment of Pellucid Marginal Degeneration 1Abdelsattar N Farrag, 2Ahmed A Hussein, 3Shiji Ummar ABSTRACT Although PMD classically has been affecting the infe- Purpose: To summarize the recent trends in the treatment rior cornea, superior PMD has also been reported, and we of pellucid marginal degeneration (PMD) based on available should consider it in the differential diagnosis of superior published data. corneal ectasia.7 The ectasia in PMD causes progressive Method and literature search: A PubMed search was con- diminution of both uncorrected and corrected visual ducted with combinations not limited to the following search acuity as a result of high against-the-rule astigmatism.1,2 terms: Pellucid marginal degeneration, Corneal ectasia, The condition is most commonly affecting males Corneal collagen cross-linking (CXL), Intracorneal ring seg- ments (ICRS), Contact lens, Keratoplasty in corneal ectasia. and usually presents between the 2nd and 5th decades 3,8 A review of the search results was performed and relevant of life. articles to the topic were included. The PMD can be diagnosed classically by slit-lamp Summary: Ophthalmologists have got a wide array of thera- examination, which shows a clear band of inferior corneal peutic modalities for the management of PMD. However, the key thinning extending from 4 to 8 o’clock. There is typically to optimal treatment is careful clinical assessment of patients a 1 to 2 mm of uninvolved normal cornea. The maximum and their visual requirements and tailoring the treatment to point of protrusion in PMD occurs in the area superior individual patients.
    [Show full text]
  • CHAMP Brochure
    To learn more about this study, please contact: Myopia can keep your child from seeing the full picture. Who is eligible to participate in the CHAMP study? To pre-qualify for this study, your child must: • Be 3 to 17 years of age • Have been diagnosed with myopia Further screening questions will be asked prior to scheduling an appointment. Learn more about CHAMP – the study of an investigational eye drop being evaluated to slow the progression of nearsightedness (myopia) in children. 21Dec2017_V1_CP-NVK002-0001_Brochure_English What will happen during the CHAMP study? • Your child will receive one drop of study medication into each eye once daily at bedtime for 4 years. • Your child’s total study participation will last approximately 4 years. • During this time, you will attend clinic visits every 3 months to receive study medication. • Every 6 months the doctor will monitor your child’s myopia closely. Your child’s eyewear prescription, the length of his or her eyes, visual function, and eye What is myopia? health will be assessed. Why should my child participate in the CHAMP study? Myopia, commonly known as “nearsightedness,” is when the eye grows too long and light does not focus accurately Myopia is increasing at an alarming rate worldwide. on the retina. This causes distant objects to appear blurry. Identifying a way to control myopia progression is a key step Typically, myopia increases during school years. Higher towards preserving eye sight and preventing serious eye myopia results in the need for thicker glasses and increases disease. By participating in this study, you and your child the risk of certain eye diseases, such as glaucoma and retinal become an important part of this effort.
    [Show full text]