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Panel session - questions from the floor

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Addressed to Prof Buckley, Ken Pullum and Dr Moodaley

Q. What do you do about problems with glare, particularly when coupled with poor night vision so that going round in ski goggles isn't a solution?

A. (Dr. M) We know that wearing a contact lens does reduce the amount of glare though it doesn't necessarily eliminate it. Other things can help such as wearing hats or visors, side shields on spectacles or lightly tinted sun specs. Generally speaking it's the contact lens that reduces the glare the most, but we know that it's a problem for a lot of people.

A. (Ken) Tinting the lenses doesn't help too much because it makes it too dark under internal illumination. It would be possible to have a tinted lens for outside wear and a clear one for inside, but it would be cumbersome.


Q. What causes scarring, does it improve with time or once you have it is that it?

A. By definition, scarring is permanent. It's been argued for years as to whether it's part of the disease process or whether it's a consequence of the management (ie wearing contact lenses). Our experience in this country is that scarring is a consequence of the disease. It would be a very badly fitting contact lens that induced scarring. Ken showed you an example of hydrops which is when the tissue of the cornea becomes waterlogged. The back layer of cells splits and water gets in and that sometimes leaves scarring which sometimes means the patient can't see as well afterwards as before the hydrops. We sometimes see patients who present with scarring at all levels in the cornea, which we can only attribute to the disease process. So I think it's wrong to incriminate the contact lens. The reason I'm emphasising that is that one or two surgeons say contact lenses don't help because they induce scarring and therefore you should have an operation. So this is another of the areas of conflict in the management of keratoconus and another reason why I think there should be a national policy for the management of keratoconus.


Q. I get dry patches on the cornea and am finding it impossible to wear lenses. What's the solution? (Aquacil were the last ones I tried, but I've given up for the last year and wear glasses, but I see distorted and don't see well enough for my job - I'm a home economics teacher).

A. (Ken) It might be that a hydrogel combination might assist, that or SoftPerm. It's possible that sclerals might assist too, because all of these help to keep the cornea hydrated. It's a question of looking at all these options to see which is best.

A. (Dr. M) Dryness or dry eyes are a very common symptom in lens wearers and there's a separate category of people that have dry eyes for some underlying reason and that should be addressed separately. I think if it's that much of a problems, it may not just be lens related and that requires its own set of investigations and possible treatment. There are a number of ways in which dry eyes can possibly be dealt with, it depends on the severity of the condition and whether there's any underlying reason for it. If eye drops don't help there are other things you might be able to go on to but without assessing the whole problem it's hard to know in your case what would be helpful. We do know that lens wear does increase the rate of evaporation of tears from the eyes so dryness is a problem across lens wearers, not just in keratoconus.


Q. If you can tolerate ordinary corneal lenses, would there be any advantage in having scleral lenses, I mean visual advantage?

A. (Ken) It's difficult to better the vision or equal the vision with scleral lenses over what you'd see with a corneal lens. There are other advantages of sclerals such as stability. It's the proximity of the corneal lens to the cornea which improves the vision if there's a choice between the two. Sometimes the vision is the same, but rarely better with sclerals.

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