Download Post Lens Tear Fogging: How Do We Resolve This? Jason Jedlicka

Post Lens Tear Fogging: How Do We Resolve This? Jason Jedlicka, OD, FAAO, FSLS, FCLSA Indiana University Disclosures •  Consultant B&L SVP •  Honorarium: Oculus, Allergan What is it? Where is it coming from? How do we get rid of it? What is it? •  Maria Walker, OD, published findings in October 2014 of 5 subjects with post lens tear fogging vs. 4 subject without post lens tear fogging –  Proteins and mucins were the same in each group –  Lipids were significantly elevated in the post lens tear reservoir in 4 of the 5 subjects with “fogging” Where is it coming from? •  “It appears that this debris responsible for creaXng turbidity within the chamber fluid either comes through or directly from the perilimbal conjuncXval Xssue” Why is it an issue? •  PaXents will complain of decreased vision or “fogging” of their vision over Xme •  Removing lenses and replacing will resolve the fogging! •  Not intermi\ent, but conXnuous and progressive with wearing Xme 1 min., 2 min., 3 min. a^er NaFl insXllaXon Less than 10 minutes a^er lens applicaXon Moments a^er NaFl InsXllaXon Tight Lens Related Fogging?? How do we get rid of it? •  OpXmize lens fit to eliminate lens movement and tear exchange Increased toricity eliminates fogging Don’t We Need Tear Exchange? •  Two Aspects to Consider: –  Delivering oxygenated tears to the cornea behind the lens1 •  Was crucial in the era of PMMA materials •  Less crucial as so^ and GP lenses became more oxygen permeable –  Remove metabolic byproducts that stagnate between the lens and cornea1 •  Reduce risk of inflammatory events and discomfort?? •  Where are these metabolic byproducts with so^ lenses?? –  Tear exchange rates with so^ lenses = 1% per blink2 •  Are we really eliminaXng metabolic byproducts? –  Tear exchange rates with rigid corneal lenses = 20% per blink2 1 Muntz A, Subbaraman L, Sorbara L, Jones L. Tear Exchange and Contact Lenses: A Review. J Optom. 2015 Jan-­‐Mar; 8(1): 2-­‐11. 2 Morrison S, Walker M, Caroline P, Kinoshita B, Lampa M, Andre M. Tear Exchange Beneath Scleral Lenses? Presented at GSLS 2016 Tear Exchange with Scleral Lenses •  Reconsidering the Two Aspects: –  Delivering oxygenated tears to the cornea behind the lens •  With Hyper DK materials and a low vault, is this necessary at all? –  Remove metabolic byproducts that stagnate between the lens and cornea •  Tear exchange with sclerals can actually PULL IN byproducts and create other issues •  With tear reservoir diluXng “metabolic byproducts”, is there a concern? •  Toxic swamp – does tear exchange help it or actually make it worse?? Lower Vault •  Less “foggy” fluid to look through •  Lower vault means less lens movement, which sXrs up debris AddiXon of Viscous Fluid to Reservoir Improve Ocular Health 1. Borchman D, Foulks G, Yappert M, Bell J, Wells E, Neravetla S, Greenstone V. Human meibum lipid conforma1on and thermodynamic changes with meibomian-­‐gland dysfunc1on. Invest Ophthalmol Vis Sci. 2011 Jun 1;52(6):3805-­‐17. doi: 10.1167/iovs.10-­‐6514 Lyne\e, Johns, OD Maria Walker, OD •  Improving the quality of the lipid secreXons from the eye and lids can only help •  “The strength of lipid-­‐lipid interacXons is 72% higher for paXent with MGD than for age matched normals”1 •  May explain why some debris is more “clumped” and other debris is more “murky” Scleral Shape •  A be\er understanding of scleral shape through use of Scleral Topography will help to provide be\er scleral alignment Highly Customized Lens Design Managing Post Lens Tear Fogging •  Keep out the debris with an opXmized fit –  Scleral alignment –  Minimal acceptable vault –  Use advanced lens design tools and opXons when necessary •  Improve ocular health •  Add viscous agents to bowl when needed