Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
Universitat Politècnica de Catalunya, University Vision Centre, Terrassa, Barcelona, Spain.
Ophthalmic Physiol Opt. 2024 Jul;44(5):884-893. doi: 10.1111/opo.13331. Epub 2024 May 22.
Soft contact lenses may be a good alternative for early-stage keratoconus (KC) patients who do not tolerate rigid gas permeable (RGP) lenses due to ocular discomfort or complications. This prospective study compared outcomes obtained after 2 weeks of wearing two types of soft silicone hydrogel contact lenses for keratoconus that varied in their diameter and central thickness (cc).
Patients with Amsler-Krumeich grades I or II KC were fitted with small-diameter (14.2 or 14.8 mm) SoftK (SD-SoftK, cc = 0.48 mm) and large-diameter (17 mm) SoftK (LD-SoftK, cc = 0.60 mm) lenses, each worn for 2 weeks in a crossover design. Low (10%;10VA) and high (100%;100VA) contrast visual acuity, contrast sensitivity (CS, Pelli-Robson), higher order aberrations (HOAs, Visionix Vx130), the number of trial lens modifications during fitting and the subjectively preferred lens were compared using Friedman tests with post-hoc analysis.
Forty eyes (N = 20, 10 males, mean age: 39.0 ± 9.9 years, range: 23-55 years) were examined. Their habitual median (interquartile1, interquartile3) 10VA (LogMAR), 100VA (LogMAR) and CS (LogCS) were 0.52 (0.30, 0.50), 0.14 (0.10, 0.15) and 1.35 (1.35, 1.50), respectively. For the SD-SoftK condition, the values were 0.23 (0.17, 0.30), 0.02 (0.00, 0.05) and 1.50 (1.50, 1.65), respectively. For the LD-SoftK condition, the respective values were 0.36 (0.27, 0.44), 0.09 (0.05, 0.13) and 1.50 (1.50, 1.60). SD-SoftK lenses significantly improved 10VA compared with habitual and LD-SoftK. SD-SoftK also significantly improved CS compared with habitual, but not LD-SoftK. LD-SoftK significantly improved spherical aberration compared with uncorrected (0.03 ± 0.10 μ vs. 0.07 ± 0.13 μ) but not SD-SoftK (0.04 ± 0.07 μ). Both lenses required a mean of 1.5 modifications prior to final lens fitting. Fewer adverse events were seen with SD-SoftK (N = 3) compared with LD-SoftK (N = 8), and 75% of participants preferred SD-SoftK lenses.
SD-SoftK lenses were preferred by 75% of subjects, were associated with fewer adverse events and significantly improved 10VA compared with LD-SoftK lenses. SD-SoftK lenses also significantly improved CS compared with the habitual correction, but this did not differ significantly from the LD-SoftK lenses.
对于因眼部不适或并发症而不能耐受硬性透气性 (RGP) 镜片的早期圆锥角膜 (KC) 患者，软性隐形眼镜可能是一种较好的替代选择。本前瞻性研究比较了两种不同直径和中央厚度 (cc) 的软性硅酮水凝胶隐形眼镜治疗圆锥角膜的 2 周佩戴结果。
使用 Amsler-Krumeich 等级 I 或 II 的 KC 患者，佩戴小直径 (14.2 或 14.8mm) SoftK (SD-SoftK，cc=0.48mm) 和大直径 (17mm) SoftK (LD-SoftK，cc=0.60mm) 隐形眼镜，每种隐形眼镜佩戴两周，采用交叉设计。使用 Friedman 检验和事后分析比较低对比度 (10%；10VA) 和高对比度 (100%；100VA) 视力、对比敏感度 (CS，Pelli-Robson)、高阶像差 (HOAs，Visionix Vx130)、配镜过程中试验镜片的修改次数以及受试者偏爱的镜片。
共检查了 40 只眼睛 (N=20，10 名男性，平均年龄：39.0±9.9 岁，范围：23-55 岁)。他们的习惯性中位数 (四分位距 1，四分位距 3) 10VA (LogMAR)、100VA (LogMAR) 和 CS (LogCS) 分别为 0.52 (0.30，0.50)、0.14 (0.10，0.15) 和 1.35 (1.35，1.50)。对于 SD-SoftK 条件，数值分别为 0.23 (0.17，0.30)、0.02 (0.00，0.05) 和 1.50 (1.50，1.65)。对于 LD-SoftK 条件，相应的值分别为 0.36 (0.27，0.44)、0.09 (0.05，0.13) 和 1.50 (1.50，1.60)。与习惯性和 LD-SoftK 相比，SD-SoftK 显著提高了 10VA。SD-SoftK 还显著提高了 CS，与习惯性相比，但与 LD-SoftK 相比则没有。LD-SoftK 与未矫正相比，显著改善了球差 (0.03±0.10μ vs. 0.07±0.13μ)，但与 SD-SoftK 相比则没有 (0.04±0.07μ)。两种镜片在最终镜片适配前平均需要 1.5 次修改。与 LD-SoftK (N=8) 相比，SD-SoftK (N=3) 的不良事件更少，75%的参与者更喜欢 SD-SoftK 镜片。
与 LD-SoftK 相比，75%的受试者更喜欢 SD-SoftK 镜片，不良事件较少，10VA 显著改善。与习惯性矫正相比，SD-SoftK 镜片还显著提高了 CS，但与 LD-SoftK 镜片相比，这并没有显著差异。
