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Anterior segment A-OCT in monitoring low grade limbal ischemia and custom scleral lens design aiming the elimination of the clinical findings

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Lefteris Karageorgiadis, BScOptom^1, Nikos Vasileiou, BScOptom², Leonidas Mavroudis, MD³, Marina Banteka, MD³

 

1. EYEART Fitting center, Thessaloniki, Greece, 2.EYEART Laboratories, Thessaloniki, Greece, 3.   LMVision clinic, Thessaloniki, Greece

 

Free Papers I | Kassandros Hall | 21/10
Thursday, Oct 21, 2021
3:30 PM - 5:00 PM
KASSANDROS HALL

The 35th International Congress of the HSIOIRS (Hellenic Society Of Intraocular Implant and Refractive Surgery) will take place at “Ioannis Vellidis” Congress Centre in Thessaloniki, on 21-23 October 2021.

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Goal:

The preference of Scleral contact lenses (SCL) has been significantly increased by practitioners and patients, as they provide a stable optical surface in challenging cases of irregular astigmatism, without being in contact with the corneal surface. Nevertheless, non-optimal fitting and prolonged wear can cause circulation blockage in blood vessels, leading to possible corneal surface degradation and limbal ischemia. OCT-Angiography, well established for the posterior segment monitoring and diagnosis, may also be used to monitor blood vessel circulation of the conjunctival and scleral region on the anterior segment. Furthermore, angiography driven lens modifications can also be used for restoring reduced circulation.

 

Method:

Two cases of SCL wearers with reduced time for comfortable wearing (4-6 hours daily) underwent OCT-Angiography to capture conjunctival and scleral blood vessel circulation. Specially modified parameters have been used, to focus on the anterior segment. Based on the findings, new lenses were designed with custom scleral landing zone geometry, aiming to relieve and restore more fluent circulation. The same monitoring procedure is performed with the new SCL.

 

Results:

Substantial relieve of circulation was achieved and the comfortable wearing time has been doubled. A follow up clinical examination, 14 and 30 after the modified fitting, showed normal anterior surface physiology.

 

Conclusions:

Anterior segment OCT-Angiography’s technology can help in monitoring blood vessel circulation in areas that the SCL is supported, enabling an ameliorated custom design of the lens, that could minimize or even eliminate clinical findings, and increase patient comfort. The usability and repeatability of the OCT-Angiography can contribute in everyday clinical diagnosis and monitoring.

Limassol, April 2020

Conference's subjects:

• Achieving the miracle with prosthetic lenses; Corneal, hydrophilic and scleral.
  Lens type selection, fitting procedure, ordering and patient management.

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• Basic principles and advanced scleral lens fitting for regular or irregular cornea.
  From slit lamp examination to OCT fitting and anterior angiography for design and fitting evaluation.
  How to do it and how to avoid long-term pitfalls.

Lefteris Karageorgiadis, Optometrist, EYEART Laboratories