AR Therapeutic CL - Yohanis

University of Gondar
College of medicine and health science

Department of optometry
ADVANCED CONTACT LENS
PREPARED BY: YOHANNES B.(BSc AND 1 ST YEAR MSc STUDENT)

MODERATOR: HAILE W.(MSc, F-LVPEI AND ASS’T PROF)
AUGUST 11 , 2021
THERAPEUTIC CONTACT LENSES IN THE TREATMENT
OF CORNEAL AND OCULAR SURFACE DISEASES—A
REVIEW
8/14/2021
2
Yohannes B. (MSc student in clinical optometry)
bizualemyohannes@gmail.com
OUT LINE
 Objective
 Introduction
 Objective of the study
 Indication
 Contraindication
 Fitting principles
 Complication
 Summary
 Limitation &critics
 Reference
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3
OBJECTIVE
At the end of this article review
o Identify the patient who is candidate for therapeutic
lens
o List the contraindication for the TCL
o Know the fitting principles
o List complication of TCL
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4
INTRODUCTION
 “therapeutic” = “therapeuein” to take care of, or to heal.
 Mainly fitted with the aim of attempting to maintain or restore the
integrity of ocular tissues
 First approved in the 1970s in the United States and protect the
cornea, relieve pain and enhance healing of the corneal surface
 Used for the management of corneal and ocular surface
diseases (OSDs).
5
8/14/2021 Yohannes B. (MSc student in clinical optometry)
INTRODUCTION……
 OSD is dry eye disease, blepharitis, meibomian gland
dysfunction, and immunologic disorders.
 Current conservative management options for OSD include
 Artificial tears,
 Topical antihistamines,
 Steroids and immunologics
 Therapeutic contact lens (TCL) usage.
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INTRODUCTION……
 The types of contact lenses used for therapeutic

purposes include soft lenses and scleral lenses.
 All types of CL have therapeutic roles.
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OBJECTIVE OF THE STUDY
to evaluate
 The indications,
 Contraindications
 Complications and
 Fitting principles
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8
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PAIN RELIEF
 Bullous keratopathy , epidermolysis bullosa, and epithelial
abrasions/erosions, bandage contact lenses (BCLs) are
commonly used to provide pain relief.
 Recurrent corneal erosions, BCLs may not increase the
likelihood of complete resolution when compared with ocular
lubrication, some patients may experience earlier relief from
symptoms.
Ahad MA, Anandan M, Tah V, et al. Randomized controlled study of ocular lubrication versus
bandage contact lens in the primary treatment of recurrent corneal erosion syndrome. Cornea.
2013;32:1311–1314
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8/14/2021
PAIN RELIEF….
 BCLs are also used postoperatively to aid in pain relief.
 After refractive surgery procedures such as
 photorefractive keratectomy (PRK) or
 laser epithelial keratomileusis (LASEK),
it is standard practice to place a bandage lens for better
pain relief.
Cherry PM. The treatment of pain following excimer laser photorefractive keratectomy:
additive effect of local anesthetic drops, topical diclofenac, and bandage soft contact.
Ophthalmic Surg Lasers. 1996;27(5 suppl):S477– S480
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8/14/2021
PAIN RELIEF….
 Controlled contralateral eye study showed that wearing soft
contact lenses had significant and clinically meaningful
beneficial effects after PRK
 visual recovery,
 pain perception, and
 reduced haze formation post-PRK as compared with
no contact lens wear. Taneri S, Oehler S, MacRae S, et al. Influence of a therapeutic soft
contact lens on epithelial healing, visual recovery, haze, and pain after photorefractive keratectomy. Eye
Contact Lens. 2018;44(suppl 1):S38–S43
 Silicone-hydrogel (SiHy) contact lenses have been shown to be

more significant in reducing subjective pain responses as
compared with non-SiHy contact lenses post-LASEK
Xie WJ, Zeng J, Cui Y, et al. Comparation of effectiveness of siliconehydrogel contact lens and hydrogel contact lens in patients
after LASEK. Int J Ophthalmol. 2015;8:1131–1135
12
8/14/2021
PAIN RELIEF….
 Soft contact lenses have successfully reducing postoperative
pain after autograft pterygium surgery.
Daglioglu MC, Coskun M, Ilhan N, et al. The effects of soft contact lens use on cornea and patient’s recovery after
autograft pterygium surgery. Cont Lens Anterior Eye. 2014;37:175–177
 BCLs resulted in more discomfort, pain and decreased quality

of sleep as compared with tight bandage patching post–
pterygium surgery.
Prat D, Zloto O, Ben Artsi E, et al. Therapeutic contact lenses vs tight bandage patching and pain following
pterygium excision: a prospective randomized controlled study. Graefes Arch Clin Exp Ophthalmol.
2018;256:2143–2148
13
8/14/2021
PAIN RELIEF….
 BCLs provide a mechanical shield to the eye resulting in

less mechanical abrasion/ contact from external eye
structures such as eyelids. Possible mechanism
concluded.
14
8/14/2021
ENHANCE CORNEAL HEALING
use
 BCL: promote epithelialization by forming a scaffold and
improving the spread of tear fluid over the ocular surface.
 patients wearing BCLs for neurotrophic keratitis had shorter
corneal ulcer healing times than treated solely with eye drops
Sun YZ, Guo L, Zhang FS. Curative effect assessment of bandage contact lens in neurogenic keratitis. Int J Ophthalmol.
2014;7:980–983.
 BCLs, in particular SiHy lenses, are also effective in promoting

healing in ocular chemical injuries.
 Scleral lenses work by providing a tear-filled precorneal
chamber and providing increased protection to the cornea from
desiccation and friction.
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8/14/2021
ENHANCE CORNEAL HEALING…….
 The United States, scleral lens is an important front line tool
for the management of many severe corneal disorders
refractory to other treatment measures or otherwise requiring
keratoplasty.
• StevensJohnson syndrome (SJS)/toxic epidermal necrolysis
(TEN),
• severe dry eye and
• neurotrophic disease.
Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular
surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens.
2005;31:130–134
16
8/14/2021
 scleral lenses improve symptoms, visual outcomes, and
corneal healing in severe OSD.
17
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 Case reports which show that scleral lenses have been
successfully used in specific conditions such as
 exposure and neurotrophic keratopathy
 mucous membrane pemphigoid
 Graves ophthalmopathy
 BCLs for post-trabeculectomy
 to prevent pain from conjunctival suture abrasive trauma
to the eyelids.
 effective in treating bleb leaks and and early hypotony
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8/14/2021
 Therapeutic BCL in post-cataract patients improved

 tear break-up time, tear meniscus height,
 subjective feeling, and corneal fluorescein staining
Shi DN, Song H, Ding T, et al. Evaluation of the safety and efficacy of therapeutic bandage
contact lenses on post–cataract surgery patients. Int J Ophthalmol. 2018;11:230–234
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8/14/2021
CORNEAL PROTECTION
CL can shield and protects the corneal surface from the
eyelids and eyelashes.
 Trichiasis
 post–ptosis surgery
 recurrent corneal erosions
 tarsal scarring
 Ectropion, entropion, or ptosis(++MRD) have some
experienced improvement
 severe cicatricial entropion where surgical repair is difficult
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8/14/2021
CORNEAL SEALING
 For corneal wound sealing purposes in corneal perforations

for <2mm diameter(A study conducted at the Singapore)Lim L, Tan
DT, Chan WK. Therapeutic use of Bausch & Lomb PureVision contact lenses. CLAO J. 2001;27:179–185
 Even in larger corneal perforations, fibrin glue and therapeutic

BCLs are used before penetrating keratoplasty (poor outcome
in the presence of active inflammation)
Sharma A, Kaur R, Kumar S, et al. Fibrin glue versus N-butyl-2- cyanoacrylate in corneal perforations. Ophthalmology.
2003;110:291–298.
Rana M, Savant V. A brief review of techniques used to seal corneal perforation using cyanoacrylate tissue adhesive.
Cont Lens Anterior Eye. 2013;36:156–158.
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8/14/2021
DRUG DELIVERY
EYE DROPS THERAPEUTIC LENSES
 frequent dosing is  higher bioavailability

inconvenient,
 extended-wear
 not cost-effective, function
and
 patient
noncompliance.
Peng CC, Burke MT, Carbia BE, et al. Extended drug delivery by contact lenses for
glaucoma therapy. J Control Release. 2012;162:152–158.
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8/14/2021
DRUG DELIVERY…..
The drug delivery techniques include
 Soaking method,
 presoaked or
 post soaked
 Molecular imprinting
 Particle-laden CL (The liposomes embedded in the CL also do
not affect transmittance within the visible light range.)
 Ion ligand polymeric systems
 superficial fluid technology
24
8/14/2021
DRUG DELIVERY…..
 More commonly used in

 prophylactic antibiotic delivery in CL wearers
 Delivery of glaucoma therapy in extended CL wearers
 Basic lens properties such as
 transparency, water content, drug stability, drug release,
 swelling, and storage modulus and other properties affecting
comfort such as ion and oxygen permeability
 This properties need to be addressed before
commercialization.
25
8/14/2021
CONTRAINDICATIONS
 infective keratitis,
 corneal anesthesia, and
 significant exposure keratopathy with inadequate eyelid position
or movement.
 corneal anesthesia due to
 reduced pain sensation, lacrimal and blink reflex
 unable to detect symptoms of complications.
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8/14/2021
CONTRAINDICATIONS…..
 localized drying of the contact lens surface would cause

discomfort and mechanical abrasions to the ocular
surface limiting its use of TCL
 significant lagophthalmos
 exposure keratopathy,
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8/14/2021
FITTING PRINCIPLES
 high oxygen transmissibility (Dk/L)
 overnight corneal edema to 4%most silicone-hydrogel
lenses, but not hydrogel lenses, are able to fulfill this criteria
 The diameter of the soft lenses should be ≥ 13.5 mm for full
corneal coverage and larger lenses (eg, Kontur lenses) may
be required in certain conditions such as post–glaucoma
filtration surgery cases.
 Consider
 Water content, ionic character and design
28
8/14/2021
FITTING PRINCIPLES…..
 steep or flat fitting lenses avoided.

 Prophylactic topical antibiotics are recommended
 preservative-free eyedrops is preferred where possible.
 periodic replacement to avoid protein and microbial
deposit
 followed up at regular intervals to check for
complications.
29
8/14/2021
COMPLICATIONS
 Infective keratitis is one of the most
 Overnight contact lens wearers had a much higher incidence of
microbial keratitis than daily-wear contact lens wearers
 highest incidence of microbial keratitis seen in overnight SiHy
wearers, even compared with overnight conventional soft lens
wearers
 Poor hygiene, extended wear, and low oxygen permeability are
contributing factors
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8/14/2021
COMPLICATIONS……..
 significant corneal hypoxia if worn on an extended-wear

 allergies and inflammation. Papillary conjunctivitis,
sterile inflammatory reactions,
 steeply fit, a sucked-on-lens syndrome or anterior
segment ischemia can develop.
 lens loss
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8/14/2021
SUMMARY
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8/14/2021
LIMITATION &CRITICS ….
Some article have low sample size
There is also prospective study may reliable
Some ideas have no reference like contraindication of TCL
33
REFERENCE
 https://www.2020mag.com/ce/therapeu
tic-contact-lenses-and-beyond-
18DEB8
 https://www.reviewofophthalmology.c
om/article/therapeutic-contact-
lensesthe-armamentarium
Volume 9, Number 6,  (https://journals.lww.com/apjoo)

November/December 2020
34
8/14/2021
35
8/14/2021

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University of Gondar

College of medicine and health science

ADVANCED CONTACT LENS

PREPARED BY: YOHANNES B.(BSc AND 1 ST YEAR MSc STUDENT)

 The types of contact lenses used for therapeutic

 Silicone-hydrogel (SiHy) contact lenses have been shown to be

 BCLs resulted in more discomfort, pain and decreased quality

 BCLs provide a mechanical shield to the eye resulting in

 BCLs, in particular SiHy lenses, are also effective in promoting

 Therapeutic BCL in post-cataract patients improved

 For corneal wound sealing purposes in corneal perforations

 Even in larger corneal perforations, fibrin glue and therapeutic

 frequent dosing is  higher bioavailability

 More commonly used in

 localized drying of the contact lens surface would cause

 steep or flat fitting lenses avoided.

 significant corneal hypoxia if worn on an extended-wear

Volume 9, Number 6,  (https://journals.lww.com/apjoo)

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