All of us Vs Keratoconus


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TOPIC: IMPORTANT STUDY-A must Read!
Anonymous

Date: Sat Jan 21 3:37 AM, 2006
IMPORTANT STUDY-A must Read!
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Ah-ha!!! have a look at this study!! There is little doubt as to the findings! 


  http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=181088


So this proves much! to what the prospects/ratios are if you have kc...


Please note their are two pages in the article above.


All the best



-- Edited by QuintriX at 05:21, 2006-01-21

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Executive

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Posts: 397
Date: Sat Jan 21 4:13 AM, 2006
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So there it is! After all this time (I have been following Dr. Karla Zadnik, and her study since the beginning of my KC) we have proof of what Prof. Lombardi has been saying for years... that contact lens wear is in deed detrimental to the keratoconic cornea. This is vital information in the progression of our way of thinking about and treating KC... it is not good enough that we are given a treatment for the sole reason of getting us back into the workforce and giving us an 'aceptable' semblance of normal life. We have to be informed as to the side effects... we have to be given the option to choose other solutions.
This information needs to be used to confront our eye specialists, they have to be moved to strive for something better than 'good enough'!!!
It will be interesting to see who, if any pick up on this development.
Hari

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Anonymous

Date: Sun Mar 12 11:24 PM, 2006
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Well it looks like we was right all along!!!!!!!!!!


This long term study (8 years) with a lot of candidates (1,209 patients) in the study, which shows that there was a differance found in the amount of scarring betweeen those who wear contact lens and those that do not and from flat fitting contacts to steep fitting contacts ... which also proves the contact lens connection to the scarring of the cornea... here are quote's from the study.


"The risk of scarring was increased 3.6-fold among patients who wore contact lenses at baseline relative to those who did not wear contact lenses. While a likely explanation for that association is that scarring and contact lenses are both associated with increased disease severity, scarring was also found to be associated with prolonged contact lens wear. For each additional hour of daily contact lens wear, the risk of scarring increased 8%."


So that shows that contacts increase scarring!


"Eyes that wore flat-fitting rigid contact lens had a 4.4-fold increased risk of scarring relative to eyes that wore steep-fitting contact lenses."


...this also proves that contact lens DO cause scarring also!.... So we have been proved right all along!  ...but the thing to note is that flatting fitting contacts (apical touch of our cones on a flat fitting contact is what causes the most harm) in what are harmful for us by about four and a half times!


"One thing that we have been concerned about is whether the way contact lenses are fitted in eyes with keratoconus makes any difference to the patient's prognosis. The take-home message from these data is that scarring is associated with worsening disease, but it is also associated with apical touch contact lens wear," she said. (Karla Zadnik, OD, PhD)


So you could say that RGP contact lens (paticularly flat fitting) do increase the chance of a transplant!


They say a good fitting contact lens does not cause scarring (is that another excuse?)... then why are the fitters which the patients in this study went to... not doing there job!... may be because its a near impossible task to get a "good fit" on such irregular cornea's! ... thats why a very good steep fitting contact lens is so important!


You would have thought these fitters would have put more effort in for this study!


So its clear that you should try to stay in glasses as long as possible or go on to soft lenses for kc, or try steep fitting RGP contacts, are the best cause of action/s to take... if you can!


...Or even if your diagnosed to avoid all this with the X linking treatment... as Dr's has expressed to me that its a "SIN" if it is not offered at diagnoses to the patient!


Others (due to doing there homework and trying other treatments) on this forum including me don't wear contacts! ...when one time we did... we thought it best not to put nothing in to our eyes!


And to note... other so called "support" forums have banned discussion on this and are trying to hush things up... like the NKCF!!!!!!!!!! (previouly the CFK done this and are resting in peace as now! ...due to them doing this before!) ... are they trying to help us or what ?


Anyway... I think its best to know... then not to know, and so then to know when its too far too late!


All the Best 



-- Edited by QuintriX at 00:07, 2006-03-13

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Executive

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Date: Thu Apr 6 8:32 AM, 2006
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We knew that since long time. The worst thing is that the doctor still say:


"The rigid lens pushes the cornea back and do not allow the cone to grow".


Wrong! Wrong! Wrong!


This is the most ridiculous and dangerous statement ever!


Years ago I was told the same and I used two years standart RGP's. During that time my vision degraded significantly, the cone growed and damaged.


Thanks to the internet I found the right track... crosslinking, glassess, NO MORE EYE rubbing etc.


So thanks them for doing the research because it proves what we suspected since much time.


 



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Phase Two

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Date: Mon May 8 4:38 AM, 2006
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The following is a very "wishy washy" Dr answering a question..


(BTW he is one of those Drs who works with computers in medicine... and so ain't really up to the job of answering clinical questions!... they are really scrapping the barrel here!)


The question:


"It was adressed in another forum and I thought it should be addressed here.
Does The wearing of RGP's worsen KC in any way?"


The answer:



"The review of the historical context is mixed and is dependent upon the strategy of the RGP Fit. The long answer is:

1. Some patients demanded good vision, and the RGP was fit for that purpose. In this strategy, the contact may cause some "scarring" of the cornea which may eventually lead to further scarring and probable surgery.

2. Some patients were fit for maximum comfort which tended to sacrifice vision. In this regard, the cornea rarely was scarred and there didn't seem to be any aggravation of the keratoconus.

3. The more recent philosophy is to try to balance the two, but often the vision was preferred over the comfort.

4. The CLERK study "...The data reported here indicate that, after controlling for disease severity in the form of corneal curvature, keratoconic eyes fitted with a rigid contact lens resulting in an apical touch fluorescein pattern did not have an increased risk of being scarred centrally at baseline..." Thus, rigid lenses did not aggravate the keratoconus nor promote it. Of course, anecdotal evidence is always possible."


-So this doctor himself says that contact lenses do scar eyes up and then he says it does not? and by using an edited conclusion, with no web address to the source of the whole study information? Why are they trying to hide things?  


The concusion has been twisted to make them feel better by editing it to justify why they have not been doing enough with giving us better treatments!  


The conclusion was saying that it can not be determined fully that MORE scarring with flat fitting lens than steep fitting lenses happens, and to properly find that out you would need to select candidates randomly. NOT that scarring does not take place at a percentage!!!!!!!!!!! Because the Cleck study say contacts do scar!!!!! and on a irregular cornea how can you get a "good" fit anyway??? (BTW read the results of the study below!!)   NOTE: this Dr can not even spell "CLEK"!  


Here is the link:     


http://lib.bioinfo.pl/auth:Gordon,MO


Comparison of flat and steep rigid contact lens fitting methods in keratoconus.


Karla Zadnik, Joseph T Barr, Karen Steger-May, Timothy B Edrington, Timothy T McMahon, Mae O Gordon


PURPOSE: The purpose of this article is to compare the safety and efficacy of flat- and steep-fitting rigid contact lenses in keratoconus.


METHODS: The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a 16-center observational study. Cross-sectional results at baseline were generated for 1091 subjects with longitudinal results from the 871 subjects who completed 8 years of follow up.


RESULTS: Of the 761 rigid contact lens-wearing patients at baseline, 41% had a scar at baseline compared with 24% of the nonrigid contact lens wearers (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.35-3.43; p = 0.001). Eighty-seven percent were fitted with flat-fitting lenses, whereas 13% were fitted with steep-fitting lenses. Rigid lens fitting method was also associated with incident corneal scarring. A greater proportion of the corneas wearing flat-fitting contact lenses were scarred (43% compared with 26% for the steep-fitted eyes; OR,= 2.19; 95% CI, 1.37-3.51; p = 0.001). After controlling for corneal curvature, the association of rigid contact lens fit and corneal scarring at baseline did not persist (adjusted OR, 1.20; 95% CI, 0.70-2.06; p = 0.52). Thirty-two percent of unscarred eyes at baseline fitted flat had developed an incident corneal scar by the eighth year follow-up visit compared with 14% of eyes fitted steep (OR, 2.93; 95% CI, 1.34-6.42; p = 0.007).


CONCLUSIONS: The data reported here indicate that, after controlling for disease severity in the form of corneal curvature, keratoconic eyes fitted with a rigid contact lens resulting in an apical touch fluorescein pattern did not have an increased risk of being scarred centrally at baseline. This "natural history" sample cannot determine causal proof that one method of fitting lenses is safer than another. To achieve this, a randomized clinical trial is needed.


 
The reason they hid the link is due to the title of the study, which clearly says:  


Comparison of flat and steep rigid contact lens fitting methods in keratoconus.


This study is not NOT about if contacts don't scar or not but the fact that the conclusion said that there was no "extra" scarring was twisted by the Dr to read that no RGPS do any scarring at all !!!!!!!! What Lies!!!!!!!!!! and there are people that beleive him or don't say nothing!!!!! whos worse?...


...by the way the Dr thinks transplants are "wonderful"   ...they just keep coming out with the same old things again and again!... this time by editing conclusions of studys! Jesus!



-- Edited by QuintriX at 22:47, 2006-05-23

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Veteran Member

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Posts: 45
Date: Thu May 3 10:36 PM, 2007
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what brands/types of lenses are the steeper fitting ones, and which ones should kc patients try to avoid (other than RGPs) based on this new published piece of research?

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Joanne in NY


Phase Two

Status: Offline
Posts: 484
Date: Thu May 10 8:36 PM, 2007
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Hi Jo, That's a terrific question and it bang on track of this topic, and also it's a subject area that every patient needs know about so that they know they have been given quality of care

Here is some more studies on this:

The Biomechanics of Keratoconus and Rigid Contact Lenses.

Article

Eye & Contact Lens: Science & Clinical Practice. 31(2):80-92, March 2005.
McMonnies, Charles W. M.Sc.

Abstract:
Purpose. To examine aspects of the genesis and progression of keratoconus through an analysis of the biomechanical forces associated with this condition, including those generated by rigid contact lenses.

Methods. The biomechanics of applanation tonometry and rigid contact lenses serve as a basis for examining contact lens adherence and the potential for contact lens induced mid peripheral corneal applanation and apical molding with apical clearance fittings.

Discussion. Some physiologic and pathologic mechanisms for increases in intraocular pressure are reviewed. The possibility is raised that hard squeeze blinks, for example, could significantly increase the distending forces that bear on the corneal apex in keratoconus and that some apical clearance contact lens fittings could increase the risk of progressive ectasia. Support for these hypotheses is found among healthy eyes and eyes with keratoconus that show increased curvature when apical clearance fittings are worn.

Conclusions. The known risk of scarring responses to excessively flat fitting rigid contact lenses must be balanced against the possible risk of molding and ectasia advancement responses to tight definite apical clearance lenses. Fittings within the range of minimal apical clearance and minimal apical contact (divided support) may be the most appropriate. The appearance and performance of these fittings may be difficult to distinguish clinically. Because some patients may develop pathologic levels of intraocular pressure with vigorous eye rubbing, strong squeeze blinks, inverted body positions, and strenuous muscular effort, patients with, or at risk for, keratoconus, glaucoma, or progressive myopia should be advised of the possible adverse significance of these activities.


http://www.claojournal.org/pt/re/eclens/abstract.00140068-200503000-00008.htm



Keratoconus Fittings: Apical Clearance or Apical Support?

Article

Eye & Contact Lens: Science & Clinical Practice. 30(3):147-155, July 2004.
McMonnies, Charles W. M.Sc

Abstract:
Purpose. To examine the relative merits of apical support and apical clearance fitting of rigid gas-permeable contact lenses for keratoconus.

Methods. After an historic review of fitting approaches for keratoconus, a case report is described in which an adventitious apical clearance fitting for early keratoconus might have been associated with accelerated progress of the ectasia.

Discussion. The hypothesis that apical clearance fittings increase the risk of accelerating ectasia progression in early keratoconus is examined in counterpoint to the hypothesis that apical support fittings increase the risk of apical scarring. Reference is made to the responses of normal corneas to apical clearance fitting and to apical contact fittings used in orthokeratology fittings. The tendency for corneas to mold to contact lens curvature is reviewed. The possibility that reduced corneal thickness or tissue softening and associated changes to the biomechanical properties of the cornea in keratoconus may facilitate molding with apical clearance fitting is examined.

Conclusions. Known and putative risk factors for fitting complications that are associated with apical clearance and apical touch contact lens fitting are given as a basis for the reader to draw conclusions about the management of contact lens fitting for keratoconus. The possibility of symptomless adverse responses is a strong indication for frequent routine aftercare reviews.


http://www.claojournal.com/pt/re/eclens/abstract.00140068-200407000-00008.htm;jsessionid=GDxQbG347D7Yk1rJMx91BTyfvMKlLxxb9lTGG9QyV8NDmCvFslzG!3145886!-949856145!8091!-1



-- Edited by QuintriX at 20:42, 2007-05-10

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