Adding Personalized Wavefront-Compensating Optics to a Contact Lens After Lens Manufacture

项目概要/摘要： 圆锥角膜是一种引起高阶光学像差的角膜疾病 （HOAs）。软性隐形眼镜不能矫正HOA，因此，刚性形式的球面隐形眼镜不能矫正HOA。 圆柱形矫正（角膜和巩膜透气接触镜）通常 在KC中定义。虽然刚性校正定量地针对球体和圆柱体，但它们依赖于 使透镜和角膜之间的泪液的折射率匹配以降低HOA。然而，在这方面， 指数匹配是一种不完全的校正形式，使具有KC的个体的眼睛高度 有畸变，视力下降。 在当今的临床中，残余HOA使得整个形式的矫正（软透镜）对于近视眼是无用的。 KC的个人，并降低了可用的有限选项的有效性 （刚性透镜）。美国国立卫生研究院已经认识到有必要提供纠正 这减少了HOA，资助了用一种称为 波前引导（WFG）校正。该方法以相同的定量方式处理HOA 作为球柱面误差，目标是测量的HOA的眼睛特定水平。WFG 校正工作，导致更好的视觉效果比索引匹配，但虽然兴趣 存在于WFG软性晶状体中，WFG矫正在临床上限于在巩膜晶状体中递送。 总的来说，该方法的临床成功率有限，只有少量的巩膜透镜 制造商提供HOA校正。这是因为当前的WFG校正方法 不与临床规范相结合，使其对临床医生和制造商的吸引力降低， 这使得病人无法接触到它们。 这一差距在公平获得低成本，临床有效的矫正个人， KC将通过这笔赠款进行桥接，该赠款将评估KC患者与 他们的临床医生识别任何符合其成本的市售透镜（软的或硬的）， 舒适度、佩戴时间和护理系统需求（如典型的视力正常患者），并适用于 事后对透镜进行HOA补偿光学校正。 该R21的前提是，临床上处方的任何球柱透镜（巩膜或软性） 通过改变HOA校正的应用方式， 到透镜。代替透镜制造商将HOA校正设计成迭代构建 在他们的透镜中，第三方将修改已经构建的透镜以包括HOA校正。 将WFG矫正添加到现有的商业球柱镜（软性或巩膜）镜片中， 在为KC提供有效的、无处不在的、低成本的纠正方面迎来了范式转变。

Project Summary/Abstract: Keratoconus (KC) is a disease of the cornea that induces higher-order optical aberrations (HOAs). Soft contact lenses cannot correct for HOAs, therefore, rigid forms of sphero- cylindrical correction (corneal and scleral gas permeable contact lenses) are commonly prescribed in KC. While rigid corrections quantitatively target sphere and cylinder, they rely on refractive index matching of the tears between the lens and cornea to reduce HOA. However, index matching is an incomplete form of correction, leaving eyes of individuals with KC highly aberrated, and with reduced vision. In today’s clinic, residual HOA renders entire forms of correction (soft lenses) useless for individuals with KC, and reduces the effectiveness of the limited options that are available (rigid lenses). The National Institutes of Health has recognized the need to deliver corrections that reduce HOA, funding work that that targeted residual HOA with a technique known as wavefront-guided (WFG) correction. This method treats HOA in the same quantitative manner as sphero-cylindrical error, targeting the eye-specific level of measured HOA. WFG corrections work, leading to better visual outcomes than index-matching, but while interest exists in WFG soft lenses, WFG corrections are limited clinically to delivery in scleral lenses. Overall, the method has found limited clinical success, with only a small number of scleral lens manufacturers offering HOA correction. This is because current WFG correction methods do not integrate with clinical norms, making them less attractive for clinicians and manufacturers, which keeps them out of reach for patients. This gap in equitable access to low-cost, clinically efficacious corrections for individuals with KC will be bridged by this grant, which will evaluate a process where KC patients work with their clinician to identify any commercially available lens (soft or rigid) that meets their cost, comfort, wear time and care system needs (as a typically-sighted patient would), and applies the HOA-compensating optical correction to that lens after the fact. The premise of this R21 is that any sphero-cylindrical lens prescribed in clinic (scleral or soft) can be modified to become a WFG correction by changing the way HOA correction is applied to the lens. Instead of a lens manufacturer designing the HOA correction into an iterative build of their lens, a 3rd party will modify an already-built lens to include HOA correction. Adding WFG correction to existing commercial sphero-cylindrical (soft or scleral) lenses will usher in a paradigm shift in the delivery of effective, ubiquitous, lower-cost corrections for KC.