Current perspectives in the management of keratoconus with contact lenses

Our aim is to review current and significant articles on contact lens wear in keratoconus patients. A comprehensive literature search of PubMed was performed for the following topics on contact lens wear in keratoconus patients: (1) characteristics of contact lens wearers, (2) safety and efficacy, (3) complications, (4) fitting techniques, (5) contact lens wear after procedures/surgeries, (6) patient satisfaction. A total of 104 studies were finally selected and reviewed. Gas permeable (GP) lens wear provided significantly better vision than glasses. Special cone design lenses had better patient comfort levels though there was no difference in best corrected visual acuity among the GP lenses. Soft lenses showed good efficacy for the treatment of mild-to-moderate keratoconus with newer designs improving visual performance such as customised hydrogel and novel pinhole lenses. Scleral and hybrid lenses provide good visual acuity and comfort for keratoconic patients previously intolerant to RGP lenses. RGP lens wear post-cross linking (CXL) is relatively well-tolerated. Contact lenses may still be required post intrastromal corneal ring procedures and post keratoplasty. Scheimpflug imaging and anterior segment optical coherent tomography (ASOCT) are useful in contact lens fitting. Computerized contact lens fitting techniques could reduce the chair time of lens fitting as well as improve comfort and visual performance. Contact lenses play an important role in the visual rehabilitation of keratoconus patients. New contact lens designs and materials have significantly expanded the available fitting options for keratoconus patients. Imaging technology can be utilized to guide contact lens fitting.摘要: 当前关于接触镜治疗圆锥角膜的观点本文旨在对圆锥角膜患者佩戴角膜接触镜的重要文献进行回顾。我们于PubMed进行了全面的文献检索, 聚焦于圆锥角膜患者佩戴接触镜的问题: (1) 接触镜佩戴者的特点 (2) 安全性和有效性 (3) 并发症 (4) 适配技术 (5) 手术后的接触镜的佩戴 (6) 患者满意度。文中最终纳入并回顾了104项研究。佩戴透气性 (Gas permeable, GP) 镜片比眼镜具有更好的视野。特殊设计的锥形镜片使病人拥有更佳的舒适度, 尽管最佳矫正视力与GP镜片之间并没有差异。软性镜片在治疗轻中度圆锥角膜方面显示出良好疗效, 新设计的如定制水凝胶和新型针孔镜片改善了视觉性能。巩膜和混合镜片为不能耐受RGP镜片的圆锥角膜患者提供了良好的视力和舒适度。佩戴RGP镜片后交联 (post-cross linking, CXL) 相对耐受性较好。角膜基质环术和角膜成形术后仍需佩戴接触镜。Scheimpflug成像和眼前节光学相干断层扫描 (anterior segment optical coherent tomography, ASOCT) 有助于接触镜的适配。计算机化的接触镜适配技术可以减少镜片配戴的占用时间, 提高舒适度和视觉性能。角膜接触镜在圆锥角膜患者的视觉康复中起着重要作用。新接触镜的设计和材料极大地扩展了圆锥角膜患者可用的适配选择。成像技术的利用有助于指导接触镜的配戴。.