Estudio de los cambios en la calidad visual y en la superficie ocular en ortoqueratología

Las lentes de contacto de ortoqueratología modifican la estructura del epitelio corneal y por consiguiente sus propiedades ópticas. Hoy en día se acepta que esta modificación en el espesor epitelial es debida a las fuerzas hidrodinámicas que ejerce la lágrima que queda entre la lente de contacto y la cara anterior de la córnea del paciente. Por eso es de importancia conocer los cambios que se puedan producir con el uso de lentes de contacto de ortoqueratología de diseño esférico y tórico y con ello poder asegurar el éxito de los casos que van a someterse al tratamiento. Este trabajo de investigación se dividió en dos partes. La primera parte fue estudiar la relación entre el astigmatismo y la elevación corneal en una población sana. Para ello se realizó un estudio retrospectivo, comparativo y observacional de una muestra de 305 pacientes sanos. En la práctica clínica esta relación condiciona el diseño de lente de ortoqueratología a adaptar minimizando los tiempos de selección y adaptación para así mejorar los resultados ópticos. Se encontró que el astigmatismo corneal y la diferencia de elevación corneal tienen una fuerte correlación y, por lo tanto, la diferencia en la elevación entre los meridianos principales se puede estimar a partir de la magnitud del astigmatismo corneal. Esto puede ser especialmente útil para la selección del diseño de lentes de ortoqueratología, principalmente con diseños tóricos cuando a priori la elección de esta geometría no está indicada en las guías de adaptación de los fabricantes. Además, la asimetría significativa entre la elevación nasal y la temporal encontrada podría explicar la tendencia de la lente de contacto a descentrarse en algunas adaptaciones..

Accommodation response and spherical aberration during Orthokeratology

Purpose: To evaluate the changes in the accommodative response and in the corneal and internal spherical aberration during three months of wear of orthokeratology lenses from the baseline. Methods: Fifty children aged 8 to 17 were recruited for a prospective study and were fitted with orthokeratology lenses. Refraction without cycloplegia, high and low uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), accommodation lag, horizontal near phoria without correction, corneal topography, corneal and total wavefront aberration were performed at baseline, 1 day, 1 week, 1 month and 3 months. Data were analysed by Student t-test for related samples, repeated measures ANOVA test and Pearson Correlation test. Results: The spherical equivalent (SE) before and after three months was -3.33 ± 1.60 D and -0.30±0.46 D, respectively. Accommodation lag was 0.53±0.38 D and 0.20±0.33 D at baseline and at three months, respectively. A moderate correlation between lag at the baseline and its change between baseline and the 3-month visit was found (P<0.05; R= 0.748). The spherical aberration (SA) increased for anterior corneal and total measurement, being statistically significant for all visits (P<0.05). The internal SA decreased: -0.105±0.006 at baseline and -0.196±0.203 at 1 week (P< 0.05). No difference between baseline and the follow up visits in posterior corneal SA was found (P>0.05) Conclusion: The negative SA of the lens increases during OK treatment compensated for the increase of the anterior corneal surface positive SA, in addition to increasing the accommodative response

Ortoqueratología en hipermetropía: una revisión sistemática

La ortoqueratología (orto-k) nocturna es un tratamiento corneal refractivo que permite compensar la refracción de forma reversible al modificar la curvatura corneal durante la noche. En relación a la hipermetropía existe la necesidad de conocer aún más cómo funciona esta técnica y conocer la evidencia científica al respecto. Esta revisión sistemática muestra el escaso número de artículos publicados hasta la fecha sobre orto-k en hipermetropía, así como la dificultad de poder extrapolar sus resultados a la práctica clínica diaria debido a su corta duración en el tiempo y a los sesgos de selección en la muestra. Aún se debe seguir estudiando sobre el funcionamiento y la eficacia de esta técnica en hipermetropía, así como llevar a cabo estudios con un mayor seguimiento en el tiempo y con un mejor diseño metodológico

Corneal surface wettability and tear film stability before and after scleral lens wear

Purpose: The aim of this study was to evaluate the anterior surface of scleral contact lens and ocular surface wettability before and after one-month of scleral lens wear in patients with keratoconus. Methods: Forty-nine patients with keratoconus (36.26 ± 9.03 years) were recruited. The sample was divided into two groups: patients with intrastromal corneal ring (KCICRS group) and patients without ICRS (KC group). TFSQ, Schirmer I test, Ocular Surface Disease Index (OSDI questionnaire), tear break-up time (TBUT) and corneal staining were evaluated in two different visits: Baseline (before lens wear) and one-month visit (10 min after lens removal). Visual Analog Scale (VAS questionnaire) was filled in just after inserting the lenses and just before removing them. TFSQ mean and inferior were evaluated over the contact lens surface at the moment of inserting the lens (baseline visit) and after 8 h of lens wear (one-month visit). Results: Anterior corneal surface TFSQ values increased in all groups after scleral lens wear (p  0.05). No changes were found in tear volume for total and in KC and KCICRS groups (p > 0.05). For all groups, there was a statistical decrease of TBUT (p < 0.05). In addition, OSDI score, corneal staining and VAS score improved after scleral lens wear from baseline in total and in both KC and KCICRS groups (p < 0.05). Conclusion: The scleral contact lens surface keeps its wettability after one-month of wear. However, the wettability of the ocular surface is worse after contact lens wearing

Comparison of Two Wavefront Autorefractors: Binocular Open-Field versus Monocular Closed-Field

Purpose. To evaluate the agreement and repeatability between a new commercially available binocular open-field wavefront autorefractor, as part of the Eye Refract system, and a monocular closed-field wavefront autorefractor (VX110). Methods. A cross-sectional, randomized, and single-masked study was performed. Ninety-nine eyes of 99 healthy participants (37.22 ± 18.04 years, range 8 to 69 years) were randomly analyzed. Three measurements with the Eye Refract and the VX110 were taken on three different days, under noncycloplegic conditions. Mean spherical equivalent (MSE), cylindrical vectors (J0 and J45), and binocular corrected distance visual acuity (BCDVA) were compared between both autorefractors. An intersession repeatability analysis was done considering the values of repeatability (Sr) and its 95% limit (r). Results. The VX110 showed more negative values (P<0.001) in terms of MSE in comparison with the Eye Refract (0.20 D). Regarding cylindrical vectors, J45 showed statistically significant differences (P=0.001) between both wavefront autorefractors, but they were not clinically relevant (<0.05 D). In BCDVA, there were no statistically significant differences (P=0.667) between both wavefront autorefractors. Additionally, the Eye Refract was more repeatable than the VX110 in terms of both MSE (SrEYE REFRACT = 0.21 D, SrVX110 = 0.53 D) and J0 (SrEYE REFRACT = 0.12 D, SrVX110 = 0.35 D). Conclusions. The Eye Refract provided enough accuracy and reliability to estimate refractive errors in different age groups, achieving better results than the VX110. Therefore, the Eye Refract proved to be a useful autorefractor to be incorporated into clinical practice

Comparison Between Aberrometry-Based Binocular Refraction and Subjective Refraction

Purpose: We evaluate the efficacy of a new system of binocular refraction, mainly based on ocular aberrometry (EYER) and compare it with the traditional subjective refraction as gold standard. Methods: A prospective, double blind, and transversal study was performed on 99 subjects (35 men, 64 women; mean age 37.22 ± 18.04 years; range, 7–70 years). Refractive surgery or irregular cornea were considered exclusion criteria. Subjective refraction was performed by three different optometrists and EYER by other optometrists on three different days randomly. The binocular best corrected visual acuity (BBCVA), subjective vision evaluated with visual analogue scale (VAS), refraction spent time, and mean spherical equivalent (MSE), and vertical and oblique cylindrical components (J0 and J45) were analyzed. Results: A positive strong correlation between EYER and subjective refraction was found for MSE (Pearson, 0.984; P < 0.001) and J0 and J45 (Pearson, 0.837; P < 0.001 and Pearson, 0.852; P < 0.001, respectively) in the total group. There were no statistically significant differences for BBCVA (P < 0.05). The VAS scores were 84.29 ± 12.29 with the EYER and 86.89 ± 12.38 with subjective refraction (P = 0.031). The spent time to perform the refraction was statistically lower (P < 0.05) with the EYER compared to conventional subjective refraction for all groups. Conclusions: The EYER system showed similar results in terms of spherical and cylindrical components, visual acuity being the spent time in the refraction lower than conventional subjective refraction. Translational Relevance: This new objective refraction system provides less chair spent time with similar results than subjective refractio

Clinical Performance of a New Hybrid Contact Lens for Keratoconus

OBJECTIVES: To compare the clinical performance of the Clearkone hybrid contact lens for the treatment of keratoconus against the habitual contact lens of the patients. METHODS: A total of 33 eyes from 18 patients were fitted with the Clearkone. High- and low-contrast visual acuity (HCVA and LCVA), central corneal thickness (CCT), and contrast sensitivity acuity (CSF) were recorded with habitual lenses (prestudy visit) and after 1 week, 15 days, and 1 month of wear of prescribed Clearkone. Subjective vision and comfort were rated using visual analogue scales (VAS). RESULTS: Three patients discontinued the study, one because of diffuse corneal staining after 1 day of use and the other two because of extreme discomfort. The rest of the patients completed the 1-month study. High contrast visual acuity and LCVA (logMAR) improved significantly from 0.16 ± 0.12 and 0.44 ± 0.22, respectively, with the patient's habitual contact lenses to -0.006 ± 0.058 and 0.23 ± 0.13 after 1 day wearing Clearkone, remaining significant during all follow-up visits (P<0.001; repeated measures analysis of variance [RM-ANOVA]). There were no statistically significant differences in the mean CCT. The improvement of CSF was statistically significant with hybrid contact lenses prescribed compared with the patient's habitual contact lenses (P<0.001; RM-ANOVA test). Improvement in VAS score, with prescribed Clearkone, was statistically significant for comfort (P=0.043; RM-ANOVA test), but not for the subjective vision (P=0.759; RM-ANOVA test). CONCLUSIONS: Clearkone provides an improvement in visual acuity, contrast sensitivity, and subjective comfort in patients with keratoconus when compared with other contact lens options. However, clinicians must get specific training to fit the lens and be aware of potential adverse events

Comparison of Intraocular Pressure before and after Laser In Situ Keratomileusis Refractive Surgery Measured with Perkins Tonometry, Noncontact Tonometry, and Transpalpebral Tonometry

Purpose. To compare the intraocular pressure (IOP) before and after Laser In Situ Keratomileusis (LASIK), measured by Diaton, Perkins, and noncontact air pulse tonometers. Methods. Fifty-seven patients with a mean age of 34.88 were scheduled for myopia LASIK treatment. Spherical equivalent refraction (SER), corneal curvature (K), and central corneal thickness (CCT) and superior corneal thickness (SCT) were obtained before and after LASIK surgery. IOP values before and after surgery were measured using Diaton, Perkins, and noncontact air pulse tonometers. Results. The IOP values before and after LASIK surgery using Perkins tonometer and air tonometers were statistically significant (). However, no significant differences were found () for IOP values measured with Diaton tonometer. CCT decreases significantly after surgery () but no statistical differences were found in SCT (). Correlations between pre- and postsurgery were found for all tonometers used, with and for the air pulse tonometer, and for Perkins, and and for Diaton. Conclusion. Transpalpebral tonometry may be useful for measuring postsurgery IOP after myopic LASIK ablation because this technique is not influenced by the treatment

Repeatability of Aberrometry-Based Automated Subjective Refraction in Healthy and Keratoconus Subjects

Purpose. To compare the intersession repeatability of the Eye Refract, a new instrument to perform aberrometry-based automated subjective refraction, on healthy and keratoconus subjects. Materials and Methods. A cross-sectional and randomized study was performed. A total of 64 participants were evaluated in the study, selecting one eye per participant randomly. The sample was divided into two different groups: 33 healthy subjects (38.85 ± 13.21 years) and 31 with keratoconus (37.29 ± 11.37 years). Three refractions per participant with the Eye Refract were performed on three different days, without cycloplegia. The repeatability analysis of refractive variables (M, J0, and J45), binocular corrected distance visual acuity (BCDVA), and spent time in refraction was performed in terms of repeatability (Sr), its 95% confidence interval (r), and intraclass correlation coefficient (ICC). Results. There were no statistically significant differences (P ≥ 0.05) between sessions in both groups for all refractive variables (M, J0, and J45) and BCDVA. Spent time in refraction was reduced as the sessions went by (P < 0.05). The Eye Refract was more repeatable for refractive errors assessment in healthy subjects (M: Sr = 0.27 D; J0: Sr = 0.09 D; J45: Sr = 0.06 D) compared to those with keratoconus (M: Sr = 0.65 D; J0: Sr = 0.29 D; J45: Sr = 0.24 D), while it was similar for BCDVA. Conclusions. The Eye Refract offered better repeatability to assess refractive errors in healthy subjects compared to those with keratoconus. Despite measurements being also consistent in keratoconus subjects, they should be treated with caution in clinical practice

Programa de formación complementaria para doctorandos: Aplicación de las nuevas tecnologías y redes sociales (FOCODO)

Este proyecto de innovación docente va dirigido específicamente a los alumnos de doctorado de las Facultades de Óptica y optometría y de Veterinaria de la Universidad Complutense. Pero también es Desarrollar un programa de formación complementaria para los doctorandos en ciencias de la salud que les permita adquirir conocimiento y habilidades en áreas paralelas al ámbito en el que están realizando sus tesis doctorales. El programa de formación tendrá 4 areas temáticas diferenciadas: - Habilidades de comunicación (como escribir un artículo científico, como hacer presentaciones orales y en poster, como escribir un Proyecto científico, como trabajar en equipo, …) - Conocimiento complementario a la tesis doctoral (estadística, metodología científica, lectura crítica de bibliografía, Buenas prácticas de laboratorio, buenas prácticas clínicas, …) - Salidas profesionales durante y después de la tesis doctoral (Becas pre y postdoctorales, búsqueda de proyectos de investigación, como colaborar con otros grupos de investigación,…) - Formación especifica en su área temática (técnicas de laboratorio, técnicas clínicas, revisiones bibliográficas,…) Se generará material de tres tipos: - Seminarios.- Son presentaciones de una hora de duración sobre temas específicos a los que se puede asistir en directo o poder ver grabado a través de YouTube. Estos seminarios serán impartidos por profesores e investigadores de los grupos de investigacion que hacen la propuesta además de contar con especialistas nacionales e internacionales - Pildoras.- Videos cortos de no mas de 3 minutos que resuman los aspectos mas importantes de cada seminario que serán colgados en las pagina de los grupos de investigacion que se creen en las redes sociales. Estas píldoras serán grabadas utilizando herramientas de grabación habituales para videos en redes sociales (croma, focos, …) - Summer/Winter School.- Curos de verano y/o invierno donde en dos-tres días intensivos se imparta formacion especifica en investigacion. En estos cursos participaran profesores y expertos internacionales y estará abierto para la matriculación de estudiantes no complutenses, tanto nacionales como internacionales. Para llevar a cabo este programa se utilizarán varias herramientas: - Plataformas digitales (YouTube) donde se colgarán los seminarios que se realicen. - Redes sociales (Instagram, Twitter,…) donde se colgarán las píldoras que se realicen y además se harán reuniones en directo para debatir temas de alguna de las áreas propuestas anteriormente. - App para móvil desde donde los alumnos puedan encontrar todo el material que se genere durante el programa. Este app puede ser gratuita para los alumnos complutenses y de pago para el resto.Depto. de Optometría y VisiónFac. de Óptica y OptometríaFALSEsubmitte