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Achieving Clearer Vision with Hybrid Contact Lenses for Keratoconus Patients

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Achieving Clearer Vision with Hybrid Contact Lenses for Keratoconus Patients

Introduction

Overview of Keratoconus and Its Impact on Vision

Keratoconus is a progressive eye disease in which the normally round cornea thins and starts to protrude into a cone-like shape. A visual acuity test, performed by eye care specialists, is crucial in diagnosing conditions like keratoconus that affect vision. This deformation causes light entering the eye to be refracted irregularly, leading to visual distortions such as blurriness, glare, and sensitivity to light.

The condition typically starts in the teenage years or early twenties and can affect one or both eyes. As keratoconus progresses, it can lead to significant visual impairment, often not fully correctable with glasses due to the irregular curvature of the cornea [2].

Mild to moderate keratoconus can be treated with prescription glasses and hybrid contact lenses, or intacs. (Source: https://eyepiceyecare.com/keratoconus/)

Clinical studies have shown that HCLs can significantly improve best corrected visual acuity in keratoconus patients compared to glasses, and they are generally well-tolerated, leading to high patient satisfaction [1][3][4][5]. However, it’s important to note that while HCLs offer excellent visual outcomes, their success heavily depends on proper fitting and individual adaptation, as some patients may experience issues such as discomfort or fitting challenges [4][6].

References:

  • [1] Serdarov, Aydogdy et al. “Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus.” Turkish journal of ophthalmology vol. 53,4 (2023): 206-212. doi:10.4274/tjo.galenos.2022.43077. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442754/
  • [2] Mahmoud, Mohamed Mamdouh Ibrahim et al. “An Updated Overview of Keratoconus Management: Review Article.” The Egyptian Journal of Hospital Medicine (2022): n. Pag. https://www.semanticscholar.org/paper/50f7b0c41aca486c873802fe74b6d2af57f3be22
  • [3] Taşcı, Yelda Yıldız et al. “Comparison of Hybrid Contact Lenses and Rigid Gas-Permeable Contact Lenses in Moderate and Advanced Keratoconus.” Turkish journal of ophthalmology vol. 53,3 (2023): 142-148. doi:10.4274/tjo.galenos.2022.82754. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286838/
  • [4] Kloeck, Dave et al. “Clinical Outcome of Hybrid Contact Lenses in Keratoconus.” Eye & contact lens vol. 47,5 (2021): 283-287. doi:10.1097/ICL.0000000000000738. https://pubmed.ncbi.nlm.nih.gov/33009254/
  • [5] Dikmetas, Ozlem et al. “Evaluation of Visual Acuity Outcomes and Corneal Alterations of New Generation Hybrid Contact Lenses in Patients With Advanced Keratoconus.” Cornea vol. 39,11 (2020): 1366-1370. doi:10.1097/ICO.0000000000002438. https://pubmed.ncbi.nlm.nih.gov/32732702/
  • [6] Harbiyeli, Ibrahim Inan et al. “Use of new-generation hybrid contact lenses for managing challenging corneas.” European journal of ophthalmology vol. 31,4 (2021): 1802-1808. doi:10.1177/1120672120942757. https://pubmed.ncbi.nlm.nih.gov/32668981/

Understanding Keratoconus

Keratoconus as a Progressive Eye Condition Leading to Visual Distortion

Keratoconus is a progressive, non-inflammatory eye disorder characterized by the gradual thinning of the normally round, dome-shaped cornea, leading to the development of a cone-like bulge. This results in significant visual impairment. The condition is characterized by paraxial stromal thinning and weakening, which leads to the distortion of the corneal surface [7].

As the cornea becomes more irregular in shape, it causes light rays to be refracted improperly, directly impacting the clarity of vision. This irregularity can be detected and monitored using various topographic indices provided by advanced imaging technologies like the Scheimpflug camera-based devices [8]. The progression of the disease varies among individuals and can occur rapidly over several years or may remain stable for a long time.

Challenges Faced by Keratoconus Patients

Patients with keratoconus face multiple visual challenges that can significantly affect their quality of life. The primary issue is blurred vision, which occurs due to the irregular deformation of the cornea, making it difficult for the eye to focus light correctly. This blurring is often not fully correctable with standard glasses, leading to a reliance on specially fitted contact lenses for better visual acuity [7].

Additionally, keratoconus patients frequently experience heightened sensitivity to light, known as photophobia. This sensitivity is due to the increased scattering of light by the irregularly shaped cornea, which can be uncomfortable and debilitating in everyday brightly lit environments [9]. These challenges necessitate ongoing adjustments in vision correction strategies and can impose significant lifestyle limitations on affected individuals.

References:

  • [7] Mishra, Sanjeeb Kumar et al. “Visual outcome of fitting Rose-K2 XL lens in a case with advanced keratoconus.” Journal of Physiological Society of Nepal (2022): n. Pag.. https://www.semanticscholar.org/paper/1d47d39f84a90d5d66cf0a363064b5e250a98ec6
  • [8] Doctor, Kumar et al. “Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers.” Indian journal of ophthalmology vol. 68,12 (2020): 2732-2743. doi:10.4103/ijo.IJO_2111_20. https://pubmed.ncbi.nlm.nih.gov/33229649/
  • [9] Balparda, Kepa et al. “Both Subjective Emotional Distress and Visual Handicap Correlate with Belin ABCD Classification in the Worse Eye as Measured with the “Keratoconus End-Points Assessment Questionnaire” (KEPAQ).” Clinical ophthalmology (Auckland, N.Z.) vol. 14 1839-1845. 30 Jun. 2020, doi:10.2147/OPTH.S261785. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335300/

Why Hybrid Contact Lenses?

Keratoconus is a progressive eye disease that can significantly impair vision by altering the shape of the cornea. Managing this condition effectively is crucial for maintaining visual acuity and quality of life. Among the various corrective options available, hybrid contact lenses have emerged as a promising solution.

This section delves into the design and advantages of hybrid contact lenses, comparing them with other types of lenses used for keratoconus, such as rigid gas permeable (RGP), soft lenses, and scleral lenses.

Hybrid Contact Lenses: A Fusion of Comfort and Precision

Hybrid contact lenses are ingeniously designed to offer the best of both worlds: the superior visual clarity of hard contact lenses and the comfort of soft lenses. The central zone of a hybrid lens is made of rigid gas permeable (RGP) material, which provides sharp vision by maintaining its shape over the irregular cornea typical of keratoconus patients.

Surrounding this rigid center is a soft skirt made from silicone hydrogel or another soft lens material, which ensures the lens sits comfortably on the eye, reducing the sensation of having a foreign object in the eye, a common complaint with traditional RGP lenses [11].

This design addresses one of the primary challenges in managing keratoconus—achieving both comfort and visual acuity. The rigid center corrects vision by creating a smooth refractive surface over the cornea, while the soft skirt helps to distribute the pressure evenly, minimizing discomfort and making the lens easier to tolerate for extended periods [11].

Comparing Lens Types for Keratoconus Management

Rigid Gas Permeable (RGP) Lenses:

  • Pros: Provide excellent visual acuity by maintaining shape over the cornea; relatively inexpensive; durable.
  • Cons: Can be uncomfortable; may dislodge easily, especially in advanced keratoconus; requires adaptation period [10][12].

Soft Lenses:

  • Pros: Comfortable to wear; easier adaptation for the wearer.
  • Cons: May not offer sufficient visual correction in moderate to severe keratoconus due to the lens flexing over the irregular cornea[7][8].

Scleral Lenses:

  • Pros: Provide excellent visual acuity; more stable on the eye and less likely to dislodge; can be more comfortable than RGP lenses after adaptation.
  • Cons: More expensive; may require more care and maintenance; insertion and removal can be challenging[2][5].

Hybrid Lenses:

  • Pros: Offer the visual benefits of RGP lenses with the comfort of soft lenses; less likely to dislodge compared to RGP lenses; suitable for a wide range of keratoconus severity.
  • Cons: Can be more expensive than other lenses; may require special care and handling; the fitting process can be more complex [11].

In conclusion, hybrid contact lenses represent a significant advancement in the management of keratoconus, providing an effective balance between visual acuity and comfort. While RGP, soft, and scleral lenses each have their place in keratoconus management, hybrid lenses offer a compelling option for patients seeking both clear vision and wearability. The choice of lens type should be based on individual patient needs, severity of keratoconus, and lifestyle considerations, with a thorough evaluation by an eye care professional.

Clinical References:

Benefits of Hybrid Contact Lenses for Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and starts to bulge into a cone-like shape. This deformation alters the path of light entering the eye towards the light-sensitive retina, resulting in distorted vision.

Hybrid contact lenses have emerged as a significant advancement in the management of keratoconus, offering benefits that surpass traditional lenses in several key areas. This discussion is grounded in the latest clinical human studies and peer-reviewed scientific evidence.

Improved Visual Acuity: “Sharpening Your Sight”

The rigid center in hybrid contact lenses plays a crucial role in keratoconus management by correcting corneal irregularities, improving how visual acuity is measured in patients, allowing for sharper vision. A visual acuity test is essential in evaluating the effectiveness of hybrid lenses in enhancing sight by measuring the clarity and sharpness of vision.

A study by Aydogdy Serdarov et al. (2023) highlighted that hybrid contact lenses, due to their design combining both the rigid gas permeable center and a softer peripheral skirt, provide significant improvements in visual acuity in patients with keratoconus [14].

The rigid portion corrects the corneal bulge typical of keratoconus, directly improving the focal point and clarity of vision for patients, showcasing a substantial remedy in vision improvement.

Enhanced Comfort: “Comfort in Your Eyes”

The soft skirt of hybrid contact lenses enhances the wearing experience, offering a more comfortable fit throughout the day compared to traditional rigid lenses.

Research by Takashi Kumanomido et al. (2022) indicates that the integration of a soft skirt significantly minimizes the discomfort often associated with rigid contact lenses [15].

This design addresses one of the key complaints by providing a cushion that reduces irritation and increases the wearable duration of the lens, facilitating not just vision correction but also wearer comfort.

Stability: “Securing Your Vision”

Hybrid lenses boast a lower risk of displacement, thanks to their unique design that combines the best of both hard and soft lenses. The stability provided by these lenses is especially beneficial for patients with keratoconus, as their corneas cannot reliably hold traditional lenses in place.

Y. Taşçı et al. (2023) observed that the soft skirt helps to keep the rigid part of the lens centered over the cornea, preventing frequent dislodgements and ensuring consistent vision correction [16]. This stability is essential for keratoconus patients, as consistent lens positioning is key to maintaining optimal visual acuity.

Ease of Use: “Streamlining Lens Management”

Adopting hybrid contact lenses comes with a learning curve, particularly concerning their maintenance and handling. However, the ease of use is significantly highlighted when compared to other specialty lenses, such as scleral lenses, which may require more intricate care routines.

Insights from clinical studies suggest that patients can quickly acclimate to the handling and maintenance procedures of hybrid lenses (Dikmetas et al., 2020). The combination of rigid and soft lens materials not only aids in achieving therapeutic outcomes but also in simplifying the daily handling of the lenses, making it a viable long-term solution for managing keratoconus [17].

References:

  • [14] Serdarov, Aydogdy, et al. “Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus.” 2023. Turkish Journal of Ophthalmology, https://dx.doi.org/10.4274/tjo.galenos.2022.43077.
  • [15] Kumanomido, Takashi, et al. “Clinical Evaluation of Flat Peripheral Curve Design with Aspherical-Curve and Multi-Curve Hard Contact Lenses for Keratoconus.” PLOS ONE, vol. 17, no. 2, 8 Feb. 2022, https://dx.doi.org/10.1371/journal.pone.0263506.
  • [16] Taşçı, Y., et al. “Comparison of Hybrid Contact Lenses and Rigid Gas-Permeable Contact Lenses in Moderate and Advanced Keratoconus.” 2023. Turkish Journal of Ophthalmology, https://dx.doi.org/10.4274/tjo.galenos.2022.82754.
  • [17] Dikmetas, O., Kocabeyoğlu, Sibel, and Mocan, M. C. “Evaluation of Visual Acuity Outcomes and Corneal Alterations of New Generation Hybrid Contact Lenses in Patients With Advanced Keratoconus.” Cornea, vol. 39, no. 7, 24 July 2020, https://dx.doi.org/10.1097/ICO.0000000000002438.

Choosing the Right Hybrid Lens

Factors to Consider When Selecting Hybrid Contact Lenses

When selecting hybrid contact lenses for keratoconus, several key factors must be taken into account to ensure the best possible outcome for the wearer. These factors include:

  • Vision Needs: The primary consideration is the specific vision correction required. Hybrid lenses are designed to offer the sharp vision of rigid gas permeable lenses with the comfort of soft lenses, making them suitable for a range of vision needs, especially in keratoconus patients where irregular cornea shape can make vision correction challenging [18].
  • Lifestyle: The wearer’s lifestyle should also influence the choice of lenses. Activities, work environment, and daily wear time can affect the suitability of different lens types. For instance, individuals involved in outdoor activities or those exposed to dusty environments may require lenses with higher oxygen permeability or lenses that are less prone to dislodging [18].
  • Eye Shape and Condition of Keratoconus: The shape of the eye and the stage of keratoconus play a crucial role in lens selection. Hybrid lenses are particularly beneficial for keratoconus patients due to their ability to vault over the cornea, providing comfort and reducing the risk of corneal scarring. The condition’s progression should be monitored regularly to adjust the lens fit as needed [18].

The Importance of Professional Fitting by an Eye Care Specialist

Achieving optimal results with hybrid contact lenses necessitates a professional fitting by an eye care specialist. This process involves:

  • Detailed Assessment: A comprehensive examination of the eye’s surface, including corneal topography, to determine the exact shape and condition of the keratoconus. This information is critical for selecting the appropriate lens design and fit [18]. Part of the professional fitting process involves conducting a visual acuity test at a specific distance to ensure the lenses provide the necessary correction.
  • Customization: Hybrid lenses often require customization to match the unique contours of a keratoconic eye. An eye care specialist can ensure that the lenses provide the necessary correction while maintaining comfort and eye health [18]. During the visual acuity test, the patient is positioned 20 feet from the chart, which plays a crucial role in determining the appropriate hybrid lens fit.
  • Follow-up Care: Regular follow-up appointments are essential to monitor the eye’s response to the lenses, make necessary adjustments, and address any complications early. This ongoing care is crucial for maintaining optimal vision and eye health [18].

References:

  • [18] Acar, Banu Torun et al. “Effects of contact lenses on the ocular surface in patients with keratoconus: piggyback versus ClearKone hybrid lenses.” Eye & contact lens vol. 38,1 (2012): 43-8. doi:10.1097/ICL.0b013e31823ff181. https://pubmed.ncbi.nlm.nih.gov/22157394/

Conclusion: Enhancing Vision with Hybrid Contact Lenses in Keratoconus Management

Potential of Hybrid Contact Lenses for Keratoconus Patients

Hybrid contact lenses (HCLs) have shown significant promise in transforming the vision of patients with keratoconus, a progressive eye disease characterized by the thinning and coning of the cornea. These lenses combine the visual clarity of rigid gas-permeable (RGP) lenses with the comfort of soft lenses, making them a valuable option for keratoconus management.

Recent studies highlight the effectiveness of HCLs in improving visual acuity in keratoconus patients. For instance, a study demonstrated that HCLs significantly improved best corrected visual acuity (BCVA) from a lower baseline to near-normal levels after lens fitting [19][21][23]. Another key advantage of HCLs is their ability to provide a stable fit and good centration, which is crucial for patients with irregular corneas [19][20][22]. This stability helps in reducing visual distortions and improving overall visual quality.

Moreover, patient satisfaction with HCLs tends to be high, particularly in terms of vision clarity and comfort, compared to other lens types [19][21]. This is particularly important as comfort and visual satisfaction are critical factors influencing the long-term adherence to contact lens use in keratoconus management.

Encouragement for Consultation on Hybrid Lenses

Given the potential benefits of hybrid contact lenses, it is advisable for patients with keratoconus to consult with their eye care providers about the possibility of switching to HCLs. This consultation should include a thorough evaluation of the patient’s specific condition, as the degree of corneal irregularity and vision needs can significantly influence the suitability and design of the lenses.

Eye care professionals can provide personalized advice based on the latest advancements in lens technology and their clinical experience. They can assess the visual and comfort needs of the patient, ensuring that the selected type of HCLs maximizes visual outcomes while minimizing potential discomfort or complications [19][20][21][22].

In conclusion, hybrid contact lenses represent a significant advancement in the optical management of keratoconus, offering improved visual acuity and patient satisfaction. Consulting with an eye care provider can help patients make informed decisions about using HCLs to achieve better vision correction and overall quality of life.

References:

  • [19] Serdarov, Aydogdy et al. “Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus.” Turkish journal of ophthalmology vol. 53,4 (2023): 206-212. doi:10.4274/tjo.galenos.2022.43077. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442754/
  • [20] Taşcı, Yelda Yıldız et al. “Comparison of Hybrid Contact Lenses and Rigid Gas-Permeable Contact Lenses in Moderate and Advanced Keratoconus.” Turkish journal of ophthalmology vol. 53,3 (2023): 142-148. doi:10.4274/tjo.galenos.2022.82754. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286838/
  • [21] Ozcan, Sait Coskun, and Deniz Ozarslan Ozcan. “Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus.” Arquivos brasileiros de oftalmologia vol. 86,1 (2023): 7-12. doi:10.5935/0004-2749.20230001. https://pubmed.ncbi.nlm.nih.gov/35170647/
  • [22] Kloeck, Dave et al. “Clinical Outcome of Hybrid Contact Lenses in Keratoconus.” Eye & contact lens vol. 47,5 (2021): 283-287. doi:10.1097/ICL.0000000000000738. https://pubmed.ncbi.nlm.nih.gov/33009254/
  • [23] Dikmetas, Ozlem et al. “Evaluation of Visual Acuity Outcomes and Corneal Alterations of New Generation Hybrid Contact Lenses in Patients With Advanced Keratoconus.” Cornea vol. 39,11 (2020): 1366-1370. doi:10.1097/ICO.0000000000002438. https://pubmed.ncbi.nlm.nih.gov/32732702/

This Article is Medically Reviewed by Oh Poh Ling

Poh Ling graduated as an optometrist from SEGi University. She believes that a person will be able to fully enjoy life when they have comfortable vision and healthy eyes. Poh Ling is involved in numerous vision screenings for the underprivileged school children and also for the public in an aim to promote awareness about the importance of regular eye examination. She enjoys travelling and playing tennis.

Her Specialties includes:

1. Specialty contact lens fitting: Keratoconus

2. Orthokeratology

Favourite Quote: “While there’s life, there is hope.” – Stephen Hawking

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