Custom-made contact lenses benefit patients with corneal diseases

Ophthalmologists at Baylor College of Medicine in Houston can now improve impaired vision of patients with damaged or transplanted corneas who cannot wear conventional contact lenses.

"There is a large group of patients who we cannot fit with conventional contact lenses, including trauma patients, patients with irregularly shaped corneas, severe dry eye or bad outcomes from Lasik surgery," said Dr. Stephen Pflugfelder, professor of ophthalmology at BCM and director of the Boston Ocular Surface Prosthesis clinic at the Baylor Eye Clinic. "This remarkable technology allows us to provide a custom-fit, prosthetic, oxygen-permeable contact lens that vaults over the cornea and improves eye sight."

Dr. Anisa Gire, therapeutic optometrist at the Baylor Eye Clinic, will begin fitting patients at the Baylor Eye Clinic at the Medical Building on the McNair Campus of BCM when it opens Nov. 4.

"We are proud to be one of two centers outside of Boston to offer this lens," said Dr. Dan B. Jones, chair and professor of ophthalmology at BCM. "It will be a major resource not only for patients who need the lens, but for the community and area ophthalmologists who previously had to refer patients to Boston to be fitted for the lens."

The cornea, the clear covering of the eye that lets light in, is a sensitive, dome-like structure that when damaged, weakens eye sight. Before the lens was made available, corneal transplant was the only option to repair damage, Pflugfelder said.

Called the Boston Ocular Surface Prosthesis the hard contact lens covers the abnormalities of the cornea with a protective, cone-shaped surface filled with saline, said Pflugfelder. It never touches the cornea, but rests on the less sensitive sclera (the white tissue surrounding the cornea) making a more comfortable fit for the patient.

The lenses are custom-made and based on eye measurements during the exam and the shape of the patient's cornea, said Pflugfelder. Patients are trained to insert and remove the lens, he said.

"Lenses are removed at night and worn all day," said Pflugfelder. "They can last up to 10 years."

"This lens has been life changing for some patients whose eye sight was totally incapacitated and paralysed, including soldiers from Iraq with burns all over their eyes," said Pflugfelder.

"There is also great research potential to study improving drug delivery to the eye," said Pflufelder. "If we could inject medications into the lens' pocket of saline that covers the cornea, we could protect the eye, keep it moist and allow cornea specialists to operate on people we cannot operate on now."

"Scleral contact lenses were among some of the first contact lens developed," said Pflugfelder. "But until the development of oxygen-permeable hard contact lenses, their benefits were not well known."

Dr. Perry Rosenthal, president and founder of the Boston Foundation for Sight and on faculty at Harvard Medical School, led the development of the Boston Ocular Surface Prosthesis.

Other institutions fitting the lens include The Doheny Eye Institute at The University of Southern California Keck School of Medicine in Los Angeles and The Massachusetts Eye and Ear Infirmary in Boston, an affiliate of Harvard Medical School.

(Source: Baylor College of Medicine: Glenna Picton: November 2008)