Visual Outcome and Adaptability of Keratoconus Patients with Rose ...

CORNEA SESSION - II
AUTHORS’S PROFILE:
Dr. MANISHA CHHABRA ACHARYA: M.B.B.S. (’99), J.N. Medical College, Aligarh Muslim
University; M.S. (2003), Institute of Ophthalmology, Aligarh Muslim University; D.N.B (2004).
Presently, Consultant, Cornea Services at Dr. Shroff’s Charity Eye Hospital, Daryaganj, New
Delhi. Recepiant of Best Paper Award-- Cornea Session in DOS 2005.
E-mail: manisha28dr@yahoo.com
Visual Outcome and Adaptability of Keratoconus Patients with
Rose K Contact Lenses in Indian Eyes
Dr. Manisha Chhabra Acharya, Dr. Umang Mathur, Dr. B. Baswati, Mr. Abhilekh Aneja,
Miss Shyama Devi
(Presenting Author: Dr. Manisha Chhabra Acharya)
Keratoconus is a bilateral, asymmetric,
chronic, progressive ectasia of the cornea
characterized by steepening and distortion of the
cornea, thinning of the apical cornea, and
sometimes corneal scarring. Keratoconus affects
people in their prime earning years and
profoundly affects their lives. The majority of
keratoconic eyes in Asian-Indian patients
demonstrate the severe stage of the disease by the
second decade . Patients experience distorted
vision that worsens with the disease progression.
Although spectacles help in early stage, most
patients require contact lenses for visual
rehabilitation. Several rigid contact lens fitting
sets available have their origin in one of the three
fitting philosophies: apical clearance, three-point
touch, and apical bearing . With no accepted
standardized protocols, the 'three-point-touch'
approach is now the most widely accepted
corneal lens fitting philosophy in clinical practice
Custom-designed rigid lenses are the new
options for patients with unacceptable fit.The
contact lenses fitting in keratoconus becomes
difficult and less successful as the disease
severity advances.
Most patients eventually undergo corneal
transplantation in one or both eyes. Contact lens
intolerance and unacceptable fit is the main
indication for keratoplasty Studies to date have
reported >90% graft survival data between 5 and
12 years from the time of transplant. However
reports of late recurrence of keratoconus have
been described from 7 to 40 years after
keratoplasty with a mean latency of roughly 17
years.Many of these cases are supported by
histological confirmation. This seems important
given the fact that most keratoconus patients
225
receive transplants at a relatively young age.
Therefore contact lenses seem important in
delaying PK to a later age especially in India
when keratoconus manifests at an earlier age as
compared to the western countries. Furthermore
visual rehabilitation is often slow and
complicated6. Even Keratoconus eyes treated
with corneal transplants frequently need contact
lenses for visual rehabilitation.
To assess the visual outcome and adaptability of
Keratoconus patients with Rose k contact lens
and compare with conventional Rigid gas
permeable contact lenses
Materials and Methods
The data of all patients with keratoconus
attending the contact lens clinic of Dr Shroff’s
Charity Eye Hospital, Delhi was analyzed.
The patients were included in the study if they
had unilateral or bilateral keratoconus as
evidenced by clinical and slit lamp examination.
The objective finding necessary for enrollment
were corneal distortion in either eyes (as seen
with keratometry or retinoscopy) and the
presence of either Fleischer’s ring ,Vogt’s striae,
scarring consistent with keratoconus or the
presence of topographic evidence suggestive of
keratoconus. The exclusion criteria for study
comprised of patients with associated ocular
disease like glaucoma, cataract, retinal pathology
or any systemic illness which could contribute
to either qualitative or quantitative reduction in
visual acuity .
Clinical records were retrospectively analyzed
for demographic aspects which included age and
gender, systemic disease association, duration of
the disease and previous contact lens history.

226 AIOC 2010 PROCEEDINGS
Clinical parameters studied included unaided
visual acuity, best corrected visual acuity with
spectacles and with contact lenses. The visual
acuity was assessed using Snellen acuity chart for
distance and near with glasses, RGP and ROSE-
K lenses and was then converted to log MAR
values. Detailed slit lamp examination was done.
Lens centration and movement was noted and
the type of fit recorded. Values of keratometry,
corneal topography and Schirmer’test were
noted.
The grading of keratoconus based on
keratometry was done for every patient. Grading
based on keratometry was as follows:
• Mild Keratoconus 52 D in 1
or both meridiansan, • Severe keratoconus >62
D in 1 or both meridians.
The contact lens choice included conventional
RGP contact lens, Rose k contact lens. The fit
assessment of conventional RGP lens trial and
Rose K lens trial was done by evaluating the
dynamic fit and static fit by fluorescein staining.
The three point touch approach was followed for
RGP lenses and feather touch for ROSE-K lenses.
Any ocular discomfort or foreign body sensation
with the lenses were noted. Patients who
complained of discomfort with RGP lenses were
advised RoseK lenses and followed up for any
ocular irritability.
Results
68 eyes of 41
patients were
analyzed of which
24 (58.5%) were
males and
17(41.5%) were
females; their
median age was 26
years.6eyes(9%)
were diagnosed to have mild Keratoconus(52D) and 4 eyes (6%) had
severe keratoconus(>62 D).
Grade of keratoconus # of eyes Percentage
Mild 6 6%
Moderate 20 30%
Advanced 37 55%
Severe 4 9%
Comparison of mean VA (RGP lenses with
ROSE-K)
Difference -0.17913433
Standard error 0.028604459
95% CI -0.235716777 to -0.122551883
Test statistic t -6.262
DF 132
Significance level P < 0.0001
Comparison of mean VA (Glasses with
ROSE K)
Difference 0.59958209
Standard error 0.046868987
95% CI 0.506870602 to 0.692293578
Test statistic t 12.793
DF 132
Significance level P < 0.0001
Main reason for drop out with conventional RGP
lenses was popping lens(3 eyes), edge lift(10
eyes), decreased BCVA(1 eyes) and in 35 eyes
patients were more comfortable with Rose K
contact lens. With Rose K contact lens BCVA
improved to 6/9 (0.18 logMAR) or better in 91.2%
(62 eyes) and all improved to 6/18 (0.48
logMAR)/better as compared to RGP contact
lenses where 60.2% (41 eyes) improved to
6/9(0.18 logMAR)/better
Out of the 35 eyes 17 had a superior adaptability
with RoseK lens, 6 patients had complains of
popping out after 2-3 hours of wear and 10
patients had edge lift. 2 patients having an
acceptable fit with both still preferred RoseK
lenses over RGP lenses.
Contact lens intolerance and unacceptable fit
remains the main indication for keratoplasty in
keratoconus patients. RGP contact lenses do not

CORNEA SESSION - II
have acceptable fit with good adaptability in all
keratoconus cases. Rose k lenses because of their
unique design fit extremely well in patients with
severe keratoconus and must be considered as an
option in patients who do not fit with
conventional RGP lenses before considering
penetrating keratoplasty.
Discussion
Keratoconus is a condition in which the cornea
assumes a complex irregular curvature caused by
central corneal thinning. The abnormal
topography of the cornea in combination with
central corneal scarring results in an impaired
visual acuity. Even in mild cases spectacles do
not correct vision adequately. Hence contact
lenses remain the mainstay of treatment in these
cases until intervention is required. Though the
results of PK are very favorable in cases of
keratoconus yet studies have shown that even
after surgery 40-50% of the patients require
contact lenses.
Good visual outcomes have been reported in
keratoconus with contact lenses. In the baseline
findings in CLEK study. the visual outcomes
with patients fitted with RGP was 6/12 or better
in 77.9% eyes. In another study by Dada et al
visual acuity was 6/9 or better in 65.03% of the
patients. In our study we found a better visual
outcome than the previous studies. In our group
the BCVA with contact lenses was 6/9 or better
in 90.8% of the eyes. This brings the importance
of changing fitting philosophy and the newer
designs and advancement in materials of contact
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6. Kremer I , Eagle RC , Rapuano CJ , Laibson PR .
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227
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