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Therapeutic Use of Contact Lenses for Ocular Surface Disease

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Title: Therapeutic Use of Contact Lenses for Ocular Surface Disease
Authors: Christine Lindberg, OD, Sonia Kim, OD, David Meyer, OD, FAAO
Date: 7/22/24
Keywords/Main Subjects: Contact lenses, ocular surface disease, bandage contact lens, scleral contact lens
Description of Case: This describes the benefits of using contact lenses to help relieve and treat ocular surface disease.
Summary of the Case: This submission reviews the benefits of using different types of contact lenses to treat ocular surface disease. These contact lenses can be very effective in relieving pain, improving visual acuity, and allowing the ocular surface to heal.

Introduction
Contact lenses are advantageous for numerous ocular conditions. Some of these conditions include:

Technological and research advances are swiftly expanding the therapeutic applications of both soft and scleral contact lenses, which are large-diameter durable gas-permeable devices. The introduction of highly oxygen-permeable contact lens materials has broadened their range of applications.

Therapeutic contact lenses (TCLs) are utilized to address various corneal conditions and ocular surface diseases, providing pain relief, promoting corneal healing, maintaining ocular homeostasis, and serving as a drug delivery system that can enhance topical therapy. Modern rigid gas permeable scleral lenses offer symptomatic relief for painful corneal diseases such as bullous keratopathy, corneal epithelial abrasions, and erosions. These lenses play a critical role in therapeutic management and visual rehabilitation by improving the ocular surface and shielding the cornea from environmental damage.

This review outlines the current evidence on the use of contact lenses in treating ocular surface diseases, aiming to enhance the understanding and management of these conditions in everyday ophthalmology or optometry practice.

The ocular surface functions as a protective barrier against a variety of eye disorders and the external environment. Ocular surface disease (OSD) includes a broad spectrum of conditions affecting the eye’s surface, resulting in discomfort, diminished vision, and tear-film instability. These conditions often lead to progressive clinical and histopathologic changes. Treating OSD is complex. It involves addressing both local and systemic issues, which can lead to physical discomfort and vision impairment, affecting a patient’s quality of life. In such cases, contact lenses are vital for therapeutic management.

Although contact lenses are commonly used to correct refractive errors, they also serve a therapeutic purpose after trauma, surgery, and in the treatment of OSD. Soft and scleral contact lenses are frequently employed for therapeutic use, providing a physical barrier between the cornea and the external environment. Additionally, these lenses treat various corneal conditions, including corneal ectasias such as keratoconus, irregular astigmatism, bullous keratopathy, corneal erosions, corneal epithelial defects, and post-surgical states like post-keratoplasty and post-laser vision correction.

This focused review examines the use of therapeutic, bandage, prosthetic, and scleral lenses for managing ocular surface diseases. This review will explore the current therapeutic roles of contact lenses in modern clinical ophthalmic practice and their potential future applications.

 

Indications for therapeutic contact lenses
Therapeutic contact lenses (TCLs) are important in managing the wide array of corneal and ocular surface diseases. The aim of using TCLs is to maintain or restore the ocular surface tissue. Indications for TCLs include: ocular surface pain relief, enhancing corneal wound healing, mechanical protection, maintenance of hydration, masking disfigurement, and an ocular drug delivery system.[1]

  1. Bandage Contact Lenses:

Bandage contact lenses (BCLs) are primarily used as mechanical barriers to protect the cornea from the environment and the abrasive effects of the eyelids. BCLs promote epithelialization by serving as a scaffold, enhancing the distribution of tear fluid across the ocular surface, aiding in corneal healing, and providing pain relief. For example, in post-ocular surgeries such as keratoplasty and refractive procedures, and in patients with eyelid conditions like trichiasis, distichiasis, ptosis, and tarsal scarring, BCLs effectively create a mechanical barrier to safeguard the cornea.[1-3]

  1. Prosthetic Contact Lenses:

Prosthetic contact lenses can significantly improve the visual aesthetics of an injured or disfigured eye. Additionally, they can aid vision by minimizing glare and replicating a circular pupil, especially in cases where the pupil shape is irregular.[1] Colored lenses offer various physical benefits. For patients with conditions such as photophobia, diplopia, coloboma, and aniridia, opaque or partially opaque lenses can provide relief. Additionally, certain conditions that require therapeutic lenses can benefit from tinted lenses, which can enhance the eye’s appearance for improved cosmesis. To create a more natural look for cosmetic lenses, the pigment is printed to replicate the fibrous structures of the human iris. Specialty labs use various techniques to create both translucent and opaque tints, catering to a wide range of therapeutic needs.[4]

III. Scleral Contact Lenses:

Scleral contact lenses (ScCL) vault the cornea and limbus, resting on the sclera. The space between the lens and cornea is filled with a fluid reservoir, acting as a liquid bandage. This setup protects the ocular surface from both desiccation and the mechanical effects of eyelids. They are indicated for correcting refractive errors due to an irregular corneal surface, providing symptomatic relief, protecting the ocular surface, healing epithelial defects, and serving as a medium for constant drug delivery. They are particularly relevant for conditions such as keratoconjunctivitis sicca or dry eye disease (DED), Stevens-Johnson syndrome, ocular cicatricial pemphigoid, Sjogren’s syndrome, rheumatoid arthritis, ocular graft-versus-host disease, and more.[1] ScCLs enhance the quality of life for patients with complex corneal diseases.

Various studies have demonstrated the effectiveness of ScCLs for DED and conditions causing dry eyes, such as primary and secondary Sjögren’s Syndrome (SS), Stevens-Johnson Syndrome (SJS), graft-versus-host disease (GVHD), exposure keratopathy, neurotrophic keratopathy, ocular cicatricial pemphigoid, atopic keratoconjunctivitis, and chemical and thermal injuries. Patients in ScCLs report reduced discomfort, decreased need for lubricants, and improved visual acuity with scleral lenses in moderate to severe DED cases.[5] The lenses available today have the potential to significantly enhance patients’ lives by improving vision and providing all-day comfort. In some cases, they are the only effective option for visual rehabilitation in severely distorted corneas and compromised ocular surfaces.[1]

  1. Drug Delivery:

Ongoing research and innovations in materials and manufacturing have significantly expanded the clinical use of contact lenses for ocular surface disease treatment. There is substantial potential for these lenses to serve as drug delivery systems for treating eye diseases. Ocular drug delivery aims to achieve therapeutic concentrations of medication at the eye’s surface. This has historically been achieved through the frequent and timely administration of eye drops. Consistent issues with this tradition have been inconvenience, drug waste, and poor patient compliance. To combat these limitations it has been suggested that therapeutic lenses could serve as a viable option for controlled and sustained drug delivery, given their extended-wear capability and higher bioavailability compared to eye drop formulations. A drug-eluting contact lens shows promise as a potential platform for controlled ocular drug delivery; however, there are currently limited clinical and commercial applications in existence.[1,5]


Conclusion
Therapeutic contact lenses (TCLs) serve multiple purposes, including alleviating ocular pain, enhancing corneal healing, protecting the cornea, stabilizing the ocular surface, and improving aesthetic appearance. These objectives can be accomplished using bandage contact lenses (BCLs), prosthetic contact lenses, scleral contact lenses (ScCLs), and eventually, drug-delivering contact lenses. The primary aim of prescribing TCLs for ocular surface disease is to improve comfort and clinical outcomes. They are an effective option for managing ocular surface diseases that do not respond to traditional treatments. Recent technological advances have shown promise in using contact lenses for drug delivery, making them a convenient and effective alternative to traditional ophthalmic drugs. Consequently, therapeutic contact lenses remain a popular choice for managing ocular surface diseases and enhancing visual recovery.

References

1) Sharma, Namrata et al. “Contact lenses for the treatment of ocular surface diseases.” Indian journal of ophthalmology vol. 71,4 (2023): 1135-1141. doi:10.4103/IJO.IJO_17_23

2) Lim L, Lim EW. Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases—A Review. Asia Pac J Ophthalmol (Phila). 2020;9(6):524-532.

doi:10.1097/APO.0000000000000331.

3) Wang, Xueyang M.D.; Jacobs, Deborah S. M.D., M.Sc.. Contact Lenses for Ocular Surface Disease. Eye & Contact Lens: Science & Clinical Practice 48(3):p 115-118, March 2022.

doi:10.1097/ICL.0000000000000879

4) Curtis M, Watters G. 25 – Cosmetic and Prosthetic Contact Lenses. Contact Lenses. January 2019:463-476. doi:10.1016/B978-0-7020-7168-3.00025-8

5) Chaudhary S, Ghimire D, Basu S, Agrawal V, Jacobs DS, Shanbhag SS. Contact lenses in dry eye disease and associated ocular surface disorders. Indian J Ophthalmol. 2023;71(4):1142-1153. doi:10.4103/IJO.IJO_2778_22

 

Copyright Statement: Christine Lindberg, Sonia Kim, David Meyer, ©2024. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/
Identifier: 127474