Two Patients With Macular Degeneration Get Artificial Retinas

LYON, France — A 72-year-old woman with dry age-related macular degeneration (AMD) was the first patient to receive an artificial retina implant as part of the multicenter PRIMAvera clinical trial, which is looking at the safety and efficacy of the PRIMA system.

“Her vision was severely impaired by this condition. We used the ETDRS chart to assess her visual acuity, as this is the current method in ophthalmology. She was able to read only nine letters,” said Laurent Kodjikian, MD, PhD, from Hôpital de la Croix-Rousse in Lyon, who is a former president of the French Society of Ophthalmology. To put that in perspective, a person with normal vision can make out 85 letters, he explained.

“The goal is to get her reading another ten letters,” he told Medscape Medical News.

The hospital where Kodjikian works is one of six centers in France selected to take part in the ongoing AMD clinical trial; other study sites are in Germany, Italy, the Netherlands, and Spain. The 38 study participants will be followed for 12 months after implantation to assess visual acuity and adverse events, and outcomes will be monitored for 3 years. Investigators hope that the findings will lead to the device receiving authorization to enter the market.

The PRIMA artificial retina system has three elements: a tiny wireless retinal implant; a pair of glasses with a camera and digital projector; and a portable processor connected to the projector. The camera captures visual scenes from the surrounding environment. The processor uses algorithms to process and simplify the images, which are then sent back to the glasses. The digital projector uses pulses of infrared light to project the processed images onto the retinal implant’s photovoltaic receptors. These receptors then convert the optical information into electrical stimulation, which excites the nerve cells of the inner retina, allowing them take in the information and transmit it, via the optic nerve, to the brain. This then induces visual perception.

A Delicate Operation

To implant the chip, Kodjikian made a rather large incision — 3.5 mm — and then peeled off the retina, all while looking through a surgical microscope.

“It’s easy to peel off the retina in a healthy eye. However, the procedure becomes more difficult in an eye affected by dry AMD, where the retina tissue is not only very thin and firmly attached to the back wall of the eye, but is also very fragile. A lot can go wrong during this step, so we have to really take our time,” he said. “You can’t go too deep, and if you go too close to the surface, you risk perforating the retina. Like walking on a very thin tightrope, there’s danger all around, and very little room for error.”

After the chip was inserted under the retina, Kodjikian put the retina tissue back into place. “This was the first time I’d ever done this kind of procedure, and it was quite a challenge,” he told Medscape.

The operation took 2.5 hours, which is much less time than the 4 to 5 hours estimated by the manufacturer.

The patient will undergo rehabilitation for 12 months to help her adapt to the system. “Our hope is that this patient will be able to see better with the implant. She probably won’t get to the point of being able to drive a car. And while reading novels in small print may not be possible, it’s quite likely that she’ll be able to read large-print editions,” Kodjikian explained.

Upon activation of the retinal prosthetic, the patient experienced visual impressions that she couldn’t see before the surgery. And 1 month after the procedure, things seem to be on track, according to a press release. “The postoperative result is excellent. There are no complications, the chip is perfectly in place and the vision has not been degraded by the operation. She should now start to improve thanks to rehabilitation,” said Kodjikian.

“Of the various artificial retina systems out there, this one is the most sophisticated because it has the most pixels. The technology will certainly continue to advance. But for the time being, the clinical study should allow us to show that it does work,” he concluded.

In December 2021, he implanted an artificial retina in a second patient, and it took him 50 minutes less than the first one.

This article originally appeared in the French edition of Medscape.

The authors have disclosed no relevant financial relationships.

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September 11, 2021

Uveitis

Overview

Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea).

Uveitis (u-vee-I-tis) warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. The condition can affect one or both eyes, and it can affect people of all ages, even children.

Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease. Many times a cause can’t be identified.

Uveitis can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent complications and preserve your vision.

Symptoms

Uvea where uveitis occurs Eye with uveaOpen pop-up dialog box

The signs, symptoms and characteristics of uveitis may include:

Eye redness
Eye pain
Light sensitivity
Blurred vision
Dark, floating spots in your field of vision (floaters)
Decreased vision

Symptoms may occur suddenly and get worse quickly, though in some cases, they develop gradually. They may affect one or both eyes. Occasionally, there are no symptoms, and signs of uveitis are observed on a routine eye exam.

The uvea is the middle layer of tissue in the wall of the eye. It consists of the iris, the ciliary body and the choroid. When you look at your eye in the mirror, you will see the white part of the eye (sclera) and the colored part of the eye (iris).

The iris is located inside the front of the eye. The ciliary body is a structure behind the iris. The choroid is a layer of blood vessels between the retina and the sclera. The retina lines the inside of the back of the eye, like wallpaper. The inside of the back of the eye is filled with a gel-like liquid called vitreous.

The type of uveitis you have depends on which part or parts of the eye are inflamed:

Anterior uveitis affects the inside of the front of your eye (between the cornea and the iris) and the ciliary body. It is also called iritis and is the most common type of uveitis.
Intermediate uveitis affects the retina and blood vessels just behind the lens (pars plana) as well as the gel in the center of the eye (vitreous).
Posterior uveitis affects a layer on the inside of the back of your eye, either the retina or the choroid.
Panuveitis occurs when all layers of the uvea are inflamed, from the front to the back of your eye.

When to seek medical advice

Contact your doctor if you think you have the warning signs of uveitis. He or she may refer you to an eye specialist (ophthalmologist). If you’re having significant eye pain and unexpected vision problems, seek immediate medical attention.

Causes

In about half of all cases, the specific cause of uveitis isn’t clear, and the disorder may be considered an autoimmune disease that only affects the eye or eyes. If a cause can be determined, it may be one of the following:

An autoimmune or inflammatory disorder that affects other parts of the body, such as sarcoidosis, ankylosing spondylitis, systemic lupus erythematosus or Crohn’s disease
An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis or tuberculosis
Medication side effect
Eye injury or surgery
Very rarely, a cancer that affects the eye, such as lymphoma

Risk factors

People with changes in certain genes may be more likely to develop uveitis. Cigarette smoking has been associated with more difficult to control uveitis.

Complications

Left untreated, uveitis can cause complications, including:

Retinal swelling (macular edema)
Retina scarring
Glaucoma
Cataracts
Optic nerve damage
Retinal detachment
Permanent vision loss

July 15, 2021

How to Maintain Your Eyeglasses

Though many of us wear glasses, very few of us realize the maintenance they actually need to keep our vision clear. Maintaining your eyewear isn’t difficult, but it does require special care. Read some of our tips for taking care of your eyeglasses

Tips for Maintaining Your Glasses

Avoid Chemical Contact

Your glasses can be very fragile depending on how they were made. Some lenses have films on them to provide UV protection, scratch or shatter resistance, or even to enhance your prescription. These films are the most fragile part of your glasses, and they can easily be destroyed by contact with certain abrasive chemicals.

While it’s obvious that you shouldn’t scrub your glasses with, say, bathroom cleaner, it’s much less obvious that everyday things we put on our skin, like lotions and sunscreen, can be nearly as bad for our sensitive glasses as the bathroom cleaner we all know we should never use.

These products can contain mild abrasives that do not harm (and sometimes can even help!) our skin but may harm the film on our glasses, especially with exposure over time.

Wash Your Hands

The only way to be certain that you are avoiding any chemical contact with your glasses is to wash your hands before handling them. Lotions and sunscreens are just two of the many things we can have on our hands; often our hands have all sorts of random things on them that we don’t notice or can’t see.

A simple hand washing before you handle your glasses can help to keep the abrasives from getting onto your lenses and can help keep everything clean.

Rinse Your Lenses

While you’re at the sink, run your glasses under a gentle stream of warm water. This will help to carefully remove any loose dirt or other debris that could scratch the lenses when you wipe your lenses.

If you were to omit this step, you might end up scratching your lenses with invisible debris. While the damage might not be visible immediately, it will degrade your lenses more quickly.

Use a Lens Cloth

Once your hands are clean and you’ve run your glasses under warm water, you can wipe the lenses off to remove any leftover oils and grime. Back away from that T-shirt and put down the paper towels! You should only use a cloth specially designed for lenses. Your local Eyeglass World will sell these as either lens cloths or microfiber cloths. Using a material that was not intended to clean glasses can and will do more damage than the little bits of dirt you’re trying to remove.

Use a Cleaning Solution

Usually, a simple rinse and wipe is enough to get your frames back to top condition. However, there are always cases where we end up with grime that just won’t come off easily.

In these cases, you should only use a cleaning solution that you get from your optometrist. These cleaners are specially formulated to be very gentle on your glasses, whereas cleaners that might work on other forms of glass could be harsh and cause damage.

Store Them Correctly

Remember, when you’ve cleaned your eyeglasses, you need to be sure to store them properly to avoid having them collect more dirt, causing you to have to repeat the process more often than necessary.

Use the case your eyewear came in to store them. Hard cases generally provide more protection than soft cases. Even though they tend to be bulkier – they’re the safer choice.

If you have any questions, stop by any of our branches

July 12, 2021

Leading causes of broken eyeglasses

After years of working with patients and their broken glasses, my experience has been:

Glasses were sat on (usually when put down on a bed while dressing/undressing), or stepped on.
Glasses were damaged during a sports or recreational activity.
Glasses were “altered” by a family pet…almost always a dog.
Glasses were destroyed by a young child. Could be the child’s or the parent’s glasses.
Glasses were damaged in luggage, backpack,etc.
Glasses were damaged by owner while attempting to do a repair at home.
Glasses were damaged by “unknown entity.” Were found destroyed on nightstand upon wakening. “They must have been defective.”

Please note that I am not counting loose or missing screws, broken nylon cords for rimless. missing nose pads or temple tips. Those parts are easily fixed and do not constitute damage. Also, home repairs using super glue, toothpicks, standard solder, epoxy resin, acetone, etc. will elevate a low level repair to the need for frame replacement, and will void manufacturers warranties.

July 10, 2021

Anti reflective lenses

Glasses with anti-reflective coating have grown in popularity as more jobs demand that employees spend time behind a computer. Everyday use of smartphones, TV viewing, and other gadgets with screens can strain the eyes even further.

In the past, AR coating was a nuisance because it would easily peel off, scratch, and get dirty easily. Today’s AR-coated lenses have improved. Their anti-reflective capabilities are “seared” into the lens.

Anti-reflective coating, also called AR coating, is created to:

Block UV rays to enhance eye protection.
Block blue light, which can help with eye strain, blurry vision, and dry eyes.
Resist smudges and scratches.
Stop water damage.

Brands such as Crizal are major purveyors of these lenses. They specialize in lenses for children and have a variety of lenses with these features. Some of their offerings are expensive.

In addition to helping you see better, AR-coated glasses are more aesthetically pleasing if you are a person who is often photographed. They let light enter more easily, allowing people to see your eyes better beneath your lenses.

June 28, 2021

Contact Lens Prescription Calculator

Click to convert your eyeglasses prescription to contact Lens prescription

May 27, 2021

After 40 years of blindness, injection of light-sensitive protein restores a man’s vision

The first successful clinical test of a technique called optogenetics has allowed a 58-year-old man to see for the first time in decades.

The man was able to see with the help of image-enhancing goggles after 40 years of blindness, thanks to an injection of light-sensitive proteins into his retina.

According to a study published by Nature Medicine on May 24, this is the first successful clinical application of optogenetics, a technique in which flashes of light are used to control gene expression and neuron firing.

The study revealed that the technique is widely used in laboratories to probe neural circuitry and is being investigated as a potential treatment for pain, blindness and brain disorders.

The clinical trial, run by the company GenSight Biologics, based in Paris, enrolls people with retinitis pigmentosa — a degenerative disease that kills off the eye’s photoreceptor cells, which are the first step in the visual pathway.

In a healthy retina, photoreceptors detect light and send electrical signals to retinal ganglion cells, which then transmit the signal to the brain.

GenSight’s optogenetic therapy skips the damaged photoreceptor cells entirely by using a virus to deliver light-sensitive bacterial proteins into the RGCs, allowing them to detect images directly.

GenSight is one of several companies developing optogenetics as a treatment for RP and other disorders of the retina.

In March, Nirenberg’s company Bionic Sight announced that four of the five people with RP it had treated with a similar optogenetic therapy and a virtual-reality headset had recovered some level of vision, although the full trial results have not yet been published.

Also, Swiss pharma giant Novartis is developing a therapy based on a different protein that is so light-sensitive that goggles might not be needed. That therapy has not yet entered clinical trials.

The researchers injected the virus into the eye of a man with RP, then waited four months for protein production by the RGCs to stabilise before testing his vision, the Nature Medicine reported.

José-Alain Sahel, an ophthalmologist at the University of Pittsburgh Medical Center in Pennsylvania and leader of the study, says that one of the challenges was regulating the amount and type of light entering the eye, because a healthy retina uses a variety of cells and light-sensitive proteins to see a wide range of light.

“No protein can replicate what the system can do,” he says. So the researchers engineered a set of goggles that captured the visual information around the man and optimised it for detection by the bacterial proteins.

Using a camera, the goggles analyse changes in contrast and brightness and convert them in real-time into what Sahel describes as a ‘starry sky’ of amber-coloured dots. When the light from these dots enters a person’s eye, it activates the proteins and causes the RGCs to send a signal to the brain, which then resolves these patterns into an image.

The trial participant had to train with the goggles for several months before his brain adjusted to interpret the dots correctly. “He was like an experimentalist, a scientist trying to understand what he was seeing and make sense of it,” Sahel says.

Eventually, he was able to make out high-contrast images, including objects on a table and the white stripes in a crosswalk. When the researchers recorded his brain activity, they found that his visual cortex reacted to the image in the same way as it would have if he had normal sight.

The man still can’t see without the goggles, but Sahel says that he wears them for several hours per day and that his vision has continued to improve in the two years since his injection.

Sahel says six other people were injected with the same light-sensitive proteins last year, but the COVID-19 pandemic delayed their training with the goggles.

A neurobiologist at the University of California, John Flannery says the study “is a big step for the field.

“The most important thing is that it seems to be safe and permanent, which is really encouraging.”

Flannery said while the image may never be as good as natural vision, it is exciting that the brain can interpret images accurately.

Other researchers are, however, calling for more studies.

Sheila Nirenberg, a neuroscientist at Weill Cornell Medical College in New York City says she looks forward to seeing whether the other people in the trial, including some who were injected with higher doses of the protein, have similar results.

“It’s interesting, but it’s an N of 1,” she says.

Karl Deisseroth, a neuroscientist at Stanford University in California who co-developed optogenetics as a lab technique, says the study is important because it is the first time that the technique’s effects have been shown in people.

“It will be interesting to try this with more light-sensitive opsins” that might not require goggles, he says. But he expects optogenetics to be most useful as a research tool that leads to therapies, rather than a therapy itself.

“What we hope to see even more of is optogenetics-guided human and clinical studies,” he says.

May 24, 2021

How to maintain health eyes

Good vision helps you perform well—at home, at work, or behind the wheel. That’s why it’s important to take a few simple steps to make sure you help keep your eyesight at its best. A regular eye exam is the best way to protect your eyesight – and an easy precaution to take. Here are some tips to help maintain eye health as you age.

Eat a Balanced Diet

fruit vegetables As part of your healthy diet, choose foods rich in antioxidants, like Vitamins A and C; foods like leafy, green vegetables and fish. Many foods – especially fatty fish, such as salmon – contain essential omega-3 fatty acids that are important to the health of the macula, the part of the eye responsible for central vision.

An inadequate intake of antioxidants, consumption of alcohol or saturated fats may create free-radical reactions that can harm the macula – the central part of the retina. High-fat diets can also cause deposits that constrict blood flow in the arteries. The eyes are especially sensitive to this, given the small size of the blood vessels that feed them.

Your eyes are unique, and have their own set of nutritional needs. Ocuvite eye vitamins are specially designed to provide a balanced combination of nutrients dedicated to the health of your eyes.* Visit Ocuvite.com to learn more.

Exercise

Exercise improves blood circulation, which improves oxygen levels to the eyes and the removal of toxins.

Get a good night’s sleep

You’ll feel the difference when you get the sleep you need. You’ll look great, you’ll perform at home or work—and good rest will support the health of your eyes.

Wash your hands

Keeping your hands clean is so important when it comes to your eyes, especially if you’re a contact lens wearer. Before you touch your eye—and before you put in or remove a contact lens—wash your hands with a mild soap and dry with a lint-free towel. Some germs and bacteria that come from your hands can cause eye infections, like bacterial conjunctivitis (pink eye). When you touch your eye, whatever is on your fingers goes right onto your eye’s surface. This is one way that people catch colds—rubbing their eyes while they have cold virus germs on their hands.

Don’t Smoke

Smoking exposes your eyes to high levels of oxidative stress. While the connection has not been clearly identified, it is known that smoking increases your risk for a variety of health conditions affecting the eye. To help you quit, visit the American Lung Association’s free online smoking cessation program – Freedom From Smoking Online – at www.ffsonline.org.

Wear Sunglasses

To protect your eyes from harmful ultraviolet (UV) light, choose sunglasses with both UVA and UVB protection. Also, wearing a hat with a brim will greatly reduce the amount of UV radiation slipping around the side of your sunglasses.

Devices and Blue Light

You’re probably using digital devices for hours each day at work and at home. These devices are exposing your eyes to high energy blue light. It’s called blue light because the wavelengths emitted are near the bluer part of the spectrum. Lutein & Zeaxanthin are eye nutrients that are concentrated in the macula and help eyes filter blue light.* Lutein and Zeaxanthin cannot be produced by our bodies on their own, so they must be obtained through diet and/or supplements. If you don’t think you’re getting enough in your diet, visit Ocuvite.com to learn more.

Here are some other tips to help when you’re on your computer:

Keep your computer screen within 20″-24″ of your eye.
Keep the top of your computer screen slightly below eye level.
Adjust lighting to minimize glare on the screen.
Blink frequently.
Take a break every 20 minutes to focus on an object 20 feet away for 20 seconds.
Use lubricating eye drops to soothe irritated, dry eyes.

April 5, 2021

Headaches and your eyes

How a Headache Can Affect Your Eyes and Vision

By Troy Bedinghaus, OD Medically reviewed by Diana Apetauerova, MD on September 08, 2020

Have you ever had a headache that affected your vision? Sometimes a headache can cause pain around your eyes, even though the headache is not associated with a vision problem. On the other hand, a headache may be a sign that your eyes are changing and that it’s time to schedule an eye exam. Although headaches are rarely a medical emergency, a severe one should not be ignored or minimized.

headaches and vision — Verywell / Luyi Wang

Headaches That Affect Vision

Vision problems can sometimes be the consequence of a headache. This is especially true with migraines and cluster headaches.

Migraine Headache

A migraine headache can cause intense pain in and around your eyes. A migraine aura resembling flashing lights, a prismatic rainbow of lights or a zig-zag pattern of shimmering lights often precedes the actual headache. The aura typically lasts around 20 minutes.

Some people who experience a migraine aura never develop the actual headache, making the diagnosis of the visual disturbances difficult.¹ Migraines can also cause tingling or numbness of the skin. People with severe migraines may experience nausea, vomiting, and light sensitivity. Medications, certain foods, smells, loud noises, and bright lights can all trigger a migraine headache.An Overview of Migraine With Aura

Cluster Headache

Cluster headaches are severe headaches that occur in clusters and typically cause pain around the eyes. The pain often radiates down the neck to include the shoulder. Other symptoms include:

Tearing
Nasal drainage
Red eyes
Eyelid droop
Changes in pupil size

Cluster headaches may occur daily for several months at a time followed by a long period with no headaches. It is not known what causes cluster headaches, but they are clearly one of the most severe headaches one can experience.

Vision Problems That Cause Headaches

On the flip side, vision problems can cause headaches when you either overwork the eyes or struggle to maintain focus. By correcting the vision problem, you can often resolve the headache.

Eye Strain

Simply overusing the focusing muscles of your eyes can cause eye strain and headaches. This is an increasing problem in our high tech world

Small-screen texting and web browsing can easily cause eye strain, in part because the words and images on a computer screen are made up of pixels and do not have well-defined edges. The eyes cannot easily focus on pixels, so they must work harder even if an image is in high-resolution.² When the eye muscles become fatigued, a headache can develop around or behind the eyes.

Farsightedness

Adults and children with uncorrected farsightedness (hypermetropia) will often experience a frontal headache (also known as a “brow ache”). If you are farsighted, you may find it difficult to focus on nearby objects, resulting in eye strain and headaches. As you subconsciously compensate for your farsightedness by focusing harder, the headaches can become worse and more frequent.

Presbyopia

Around the age of 40, people begin to find it difficult to focus on nearby objects. Near point activities, such as reading or threading a needle, are often difficult to perform because of blurring. This is an unavoidable condition known as presbyopia that affects everyone at some point. Headaches develop as you try to compensate for the lack of focusing power. Reading glasses can often relieve the underlying eye strain.

Occupations requiring close-up work, exposure to sunlight for longer periods of time, and farsightedness were the most common risk factors for presbyopia.³Presbyopia: Close-Up Vision Loss and What to Do About It

Giant Cell Arteritis

Also known as temporal arteritis, giant cell arteritis (GCA) is an inflammation of the lining of the arteries that run along the temple. GCA usually creates a headache that causes constant, throbbing pain in the temples. Vision symptoms occur as a result of a loss of blood supply to the optic nerve and retina. Other symptoms include:

Fever, fatigue and muscle aches
Scalp tenderness
Pain while chewing
Decreased vision

GCA is considered a medical emergency. If left untreated, the condition may cause vision loss in one or both eyes. A delayed diagnosis is the most common cause of GCA-associated vision loss.⁴2:18

What Is a Retinal Migraine?

Acute Angle-Closure Glaucoma

Acute angle-closure glaucoma (AACG) is a rare type of glaucoma that causes a sudden onset of symptoms, including headaches. Eye pressure rises quickly in AACG causing increased eye redness, eye pain, and cloudy vision. A mid-dilated pupil (in which pupil dilation is sluggish and incomplete) is one of the most important diagnostic features of AACG.⁵

Ocular Ischemic Syndrome

Ocular ischemic syndrome (OIS) is a condition that develops due to a chronic lack of blood flow to the eye. This condition often causes a headache, decreased vision, and a host of other signs, including cataracts, glaucoma, iris neovascularization (the development of new weak blood vessels in the iris), and retinal hemorrhage. White spots on the retina indicate a lack of blood flow and oxygen to the retinal tissue.2:18

What Is a Retinal Migraine?

Herpes Zoster

Also known as shingles, herpes zoster is known for causing headaches, vision changes and severe pain around the head and eye. Herpes zoster is a reactivation of the chickenpox virus and affects a single side of the body. A headache usually precedes an outbreak of painful skin blisters.

Herpes zoster around the eyes is serious and requires immediate medical attention (including antiviral medication) to prevent damage to the ocular nerves and eyes. Complications include corneal clouding, glaucoma, and optic nerve atrophy (deterioration).⁶

Pseudotumor Cerebri

Pseudotumor cerebri is a condition that occurs when the pressure within the skull increases for no apparent reason. For this reason, pseudotumor cerebri is also referred to as Idiopathic Intracranial hypertension (“idiopathic” meaning of unknown origin and “hypertension” meaning high blood pressure).

Pseudotumor cerebri often causes a headache and changes in vision. If left untreated, pseudotumor cerebri can lead to vision loss as the pressure places strain on the optic nerves. Fortunately, while 65% to 85% of people with pseudotumor cerebri will experience visual impairment, the condition is usually transient and will normalize when the hypertension is controlled.

February 3, 2021

Bandage Contact Lenses

The Case for Bandage Soft Contact Lenses

A primer on the use of these therapeutic lenses to serve and protect the corneas of our patients.

By Susan Gromacki, O.D., M.S., F.A.A.O.

The concept of a protective eye bandage originated in the first century A.D., when Celsus reportedly applied a honey-soaked linen to the site of a pterygium removal to prevent symblepharon development.^1,2 Bandage soft contact lenses were first used in the 1970s following the development of hydroxyethyl methacrylate (HEMA) by Otto Wichterle.² With the recent advances in material technology, today’s bandage contact lenses provide the same benefits as their predecessors—but with enhanced convenience, improved healing and increased corneal health.

Bandage Lens Basics
By definition, a bandage contact lens protects the cornea. Many different lens types can be utilized to accomplish this goal (see tables 1 and 2); however, because of their high oxygen permeability and FDA approval for extended wear, silicone hydrogel soft contact lenses are currently most practitioners’ first choice.

Bandage lenses protect the cornea not only from potential exterior sources of injury, but also from a patient’s own eyelids. The shearing effect created by the lids during the blink can inhibit re-epithelialization and cause pain. Use of a bandage lens facilitates corneal healing in a pain-free environment.

Depending on the patient’s ocular condition, he or she may wear their therapeutic lenses for a period of days to years. They may be utilized for daily or extended wear (see table 2). Because there is generally an underlying disease process precipitating the need for a therapeutic lens, extra caution must be taken to clean and disinfect the lens after wear, keeping in mind that silicone hydrogel lenses tend to deposit lipids more readily than HEMA lenses (see image 1). That said, the addition of a digital rubbing step is necessary for lenses that are used more than once.

It is critical to perform frequent follow-ups for bandage contact lens patients. One reason is that a bandage lens fit, by design, demonstrates less movement than a traditional soft lens fit. The theory is to provide increased patient comfort while preventing the healing epithelial cells from sloughing off due to any mechanical trauma of the lens itself.³ In addition, it is important for the practitioner to be vigilant regarding the detection of signs of microbial keratitis. The compromised cornea—especially when wearing lenses in an extended wear modality—is at particular risk for infection.⁴

Indications
Bandage contact lenses are indicated for many different reasons, including: protecting the eyes, increasing comfort, facilitating healing and sealing wound leaks. We’ll explore these indications, and others, in more detail in the following paragraphs.

• Protection. Corneal protection is needed in the case of several conditions, including: entropion, trichiasis, tarsal scars, recurrent corneal erosion, post-surgical ptosis and surgical sutures or exposed suture knots.

Recurrent erosions are a typical sequella of epithelial basement membrane (basal lamina) trauma or are secondary to anterior basement membrane dystrophy, anterior basement membrane degeneration or stromal dystrophy. A bandage contact lens is the second line of treatment, after hyperosmotic drops and/or ointment fail.^2,5 An added benefit is the enhanced vision provided by the smooth refracting surface of the contact lens, as opposed to an irregular anterior corneal surface.5 Hypertonic saline drops should continue to be utilized concurrently with the lenses.

• Pain relief. The mitigation of corneal pain is another important indication for therapeutic contact lenses. The conditions most in need of this therapy include bullous keratopathy; epithelial erosion and abrasion; filamentary keratitis; and postoperative penetrating keratoplasty.

In bullous keratopathy, endothelial failure results in corneal edema, which in turn creates epithelial blisters that rupture, causing pain, foreign body sensation, and photophobia. A bandage contact lens reinforces the damaged tissues and protects the nerve endings from the abrasive actions of the eyelids. Patients who are awaiting a conjunctival flap or cornea transplant may be fitted with therapeutic lenses for up to 30 days at a time.²
Until recently, pressure patching was the standard of care for treating large epithelial abrasions (see figure 2). With this treatment, the caveat was to refrain from patching contact lens wearers or injuries caused by presumed vegetative matter or false fingernails. The utilization of a bandage contact lens provides protection and healing for all three of these conditions, and it has now supplanted patching as the standard of care. The authors of the Wills Eye Manual caution, however, that prophylactic topical antibiotics should be used concurrently and that daily follow-up care is mandatory.⁶

The other advantage of bandage contact lenses over patching is the ability to continue to install topical ophthalmic medications. This is particularly important after a corneal abrasion, erosion, or corneal refractive surgery, which necessitate the frequent installation of antibiotics and/or artificial tears. Some reports caution against the installation of cycloplegic agents (which reduce the pain associated with a corneal abrasion/erosion or after corneal refractive surgery) in bandage CL wearers. The dilating drops can cause the bandage lenses to dry out and become less comfortable, especially overnight, with the end result a potentially decreased healing response.⁷ On the other hand, bandage contact lenses can be utilized—by design—as vehicles for drug delivery, but the exact way to ensure a consistent dosage is still under investigation.

• Healing. The use of bandage contact lenses to facilitate healing is particularly necessary for the following conditions: chronic epithelial defects, corneal ulcer, neurotrophic keratitis, neuroparalytic keratitis, chemical burns and basement membrane disease.

They also enhance healing following corneal surgery, particularly refractive surgery. They protect the cornea from exposure or from the irritation caused by rubbing the eye as the corneal wounds are healing. Therapeutic bandage contact lenses are a mainstay after photorefractive keratectomy (PRK) procedures, in which the removal of the epithelium leaves an open wound that takes about one week to heal (see figure 3). They are also valuable for the following procedures: laser-assisted in situ keratomileusis (LASIK), laser-assisted subepithelial keratomileusis (LASEK), Epi-LASIK, penetrating keratoplasty (PK) and phototherapeutic keratectomy (PTK), lamellar grafts and corneal flaps.

• Sealing. The lenses also may aid in sealing leaky wounds. Serving as a splint or sealant, the lenses can be beneficial after cataract, penetrating keratoplasty or glaucoma filtering surgery.

• Maintenance of corneal hydration. The role of bandage contact lenses in dry eye is controversial. For patients who need to continually instill lubricating drops into their eyes, particularly after refractive surgery, the benefits of using a bandage lens can be great. Other patients who benefit are those who have significant lagophthalmos and subsequent corneal exposure. However, contact lenses are generally contraindicated for dry eye.⁷

• Structural stability and protection in piggyback lens fitting. Many patients benefit from the utilization of a soft and rigid lens concurrently. The rigid lens provides crisp vision, particularly for irregular corneas, and the soft bandage lens protects the cornea, preventing irritation and abrasions. Examples include elevation differences in the host/graft junction, keratoconus and in the presence of scar tissue.

Contraindications

Each clinician must assess his patient’s condition carefully to determine whether a bandage contact lens is warranted. Interestingly, many of the conditions that require bandage contact lenses (dry eye, infection, inflammation, etc.) contraindicate lens wear in general. In addition, therapeutic contact lenses should not be used in patients who are unwilling or unable to comply with the necessary treatment and follow-up.

Dr. Gromacki is a diplomate in the Cornea, Contact Lens and Refractive Technologies Section of the American Academy of Optometry. She is Chief Research Optometrist at Keller Army Community Hospital, West Point, New York.

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