Contact lenses as the best conservative treatment of newly diagnosed keratoconus - epidemiological retrospective study [Kontaktne leće kao najbolji izbor u konzervativnom liječenju keratokonusa - epidemiološka retrospektivna studija]

Mrazovac, Danijela and Barišić Kutija, Marija and Vidas, Sania and Kuzman, Tomislav and Petriček, Igor and Jandroković, Sonja and Kalauz, Miro and Cerovski, Branimir (2014) Contact lenses as the best conservative treatment of newly diagnosed keratoconus - epidemiological retrospective study [Kontaktne leće kao najbolji izbor u konzervativnom liječenju keratokonusa - epidemiološka retrospektivna studija]. Collegium Antropologicum, 38 (4). pp. 1115-1118. ISSN 0350-6134

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Abstract

Keratoconus is a progressive, non-inflammatory corneal ectasia characterized by thinning and weakening of the corneal stroma which results in its' protrusion. The onset is during puberty and progresses until the fourth decade of life. In earlier stages, good visual acuity can be provided with spectacles. With progression, contact lenses are considered to be a better therapy. Aim of this study was to determine if there is statistically significant difference between best corrected visual acuity (BCVA) obtained by spectacles and contact lenses in newly diagnosed keratoconus patients, as well as to determine which type of contact lenses provide better BCVA in keratoconus patients. We conducted a 5-year retrospective study of all 2891 patients attending our Contact Lens Department for the first time, searching for patients newly diagnosed with keratoconus. Data were obtained on gender, age, education level, treated eyes, corneal changes, keratoconus severity, BCVA with spectacles, contact lenses and best fitted contact lens type. All patients underwent standard ophthalmic exam, refractometry and keratometry have been done, followed by a spectacles correction and lens fitting. Wilcoxon signed rank test was used for statistical analysis. Results showed that of all 2891 patients examined for the first time, 137 patients (4.74%) have been newly diagnosed with heratoconus, there was male bias (72.26%), mean age 27.7 +/- 9.9 years. Most patients had high school education (51.11%), 3.70% had present corneal changes, 50.37% had mild heratoconus. Majority had keratoconus on both eyes (36.3%) or keratoconus of right eye (26.67%). There was a statistically significant difference (p<0.001) between the BCVA obtained with contact lenses (0.82 +/- 0.21 Snellen chart) rather than spectacles (0.37 +/- 0.27 Snellen chart). The best corrected visual acuity was achieved with rigid gas permeable (RGP) lenses in majority of kera- toconus eyes (51.85%), with semi-gas permeable (SGP) lenses in 43.39%, in 4.23% with polymethyl methacrylate (PMMA) lenses and with hard-soft gas permeable (GP) contact lenses in 0.53% of keratoconus eyes. We have showed that there is a statistically significant difference in BCVA achieved better with contact lenses than with spectacles. RGP lenses are most frequently used in conservative treatment of heratoconus, but SGP lenses were also shown to be a good option that gives equally satisfying final visual acuity with subjective comfortable feeling of contact lens wear.

Abstract in Croatian

Keratokonus je progresivna, neupalna ektazija rožnice, karakterizirana stanjivanjem i oslabljenjem strome rezultirajući protruzijom rožnice. Tipično se pojavljuje u doba puberteta i napreduje do četvrtog desetljeća života. U ranim stadijima, dobra vidna oštrina postiže se korekcijom naočalama, a progresijom bolesti kontaktne leće pokazale su se boljom terapijom. Cilj ovog istraživanja je odrediti postoji li statistički značajna razlika u najboljoj korigiranoj vidnoj oštrini između naočala i kontaktnih leća, te s kojom vrstom leća u pacijenata s keratokonusom postižemo najbolju vidnu oštrinu. Proveli smo petogodišnju retrospektivnu studiju svih 2891 novopregledanih pacijenata u Kabinetu za leće, tražeći pacijente s novodijagnosticiranim keratokonusom. Obrađivali smo podatke vezano uz spol, dob, stručnu spremu, tretirane oči, vidljive promjene rožnice, težinu keratokonusa, najbolju korigiranu vidnu oštrinu s naočalama, kontaktnim lećama i tip kontaktnih leća s kojima je takva vidna oštrina postignuta. Svi pacijenti prošli su standardni oftalmološki pregled, učinjene su refraktometrija i keratometrija, korekcija naočalama i kontaktnim lećama. U statističkoj analizi koristili smo Wilcoxonov test ekvivalentnih nizova. U rezultatima smo pokazali da je kod 4,74% pacijenata (137 od 2891) koji su prvi puta pregledani u Kabinetu za leće dijagnosticiran keratokonus. 72,26% pacijenata su bili muškarci, prosječna životna dob pacijenata 27,7±9,9 godina. Većina pacijenata (51,11%) imala je srednju stručnu spremu. 3,70% je imalo već prisutne promjene na rožnici, 50,37% pacijenata je imalo blagi oblik keratokonusa, najveći broj pacijenata (36,3%) imao je keratokonus oba oka, te keratokonus samo desnog oka (26,67%). Najbolja korigirana vidna oštrina s naočalama je bila 0,37±0,27, a s kontaktnim lećama 0,82±0,21 prema Snellenu, postoji statistički značajna razlika u korist kontaktnih leća (p<0,001). Što se tiče tipova kontaktnih leća, u 51,85% pacijenata najbolja korigirana vidna oštrina potignuta je s RGP kontaktnim lećama, u 43,39% SGP lećama, u 4,23% PMMA, u samo 0,53% tvrdo-mekim GP lećama. Ovim istraživanjem pokazali smo da postoji statistički značajna razlika u najboljoj korigiranoj vidnoj oštrini s kontaktnim lećama u odnosu s naočalama. RGP kontaktne leće su najčešće korištene u konzervativnom liječenju keratokonusa, ali i SGP leće su se pokazale dobrim izborom u postizanju optimalne vidne oštrine u pacijenata s keratokonusom, uz subjektivno ugodniji osjećaj nošenja kontaktne leće.

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