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    Specialty lens advances expand options for patients with corneal ectasia

    Innovations in designs, materials may accommodate those with contact lens intolerance



    Specialty lenses are filling the gap for patients with corneal ectasia who previously were considered intolerant of contact lenses.



    Boston—Advances in specialty lenses are enhancing treatment options for corneal ectasia in patients who previously may have been intolerant of contact lenses.

    “New designs and materials are more comfortable and physiologic,” said Deborah S. Jacobs, MD, medical director, Boston Foundation for Sight, Needham, and assistant clinical professor of ophthalmology, Harvard Medical School, Boston.

    The initial treatments for corneal ectasia—which include keratoconus, pellucid marginal degeneration, keratoglobus, Terrien’s marginal degeneration, and post-LASIK ectasia—are correction of the refractive error using spectacles, soft spherical and toric lenses, and conventional rigid gas-permeable (RGP) lenses.

    These options are best when myopia predominates over astigmatism and when the dominant eye is less affected. In addition, only RGP corneal lenses can correct irregular astigmatism, Dr. Jacobs noted.

    With corneal ectasias it is less likely that the preferred RGP fit—lid attachment—can be achieved, because the corneal RGP lens moves to the steepest part of the cornea, which in the ectasias is typically inferiorily. The result is an intrapalpebral fit, which is inherently less stable. The only choice then is to fit “tight.” And therein lies the rub—the patient may end up as being intolerant to the contact lens because of instability with lenses “popping out” or because of scarring or discomfort because of apical bearing and hypoxia.

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