![]() ![]() Dr Jacobs added that there are now optometrists who study for an extra year in their cornea and contact lens residencies and are trained in scleral lens fitting. “The technology is no longer considered a boutique technology many lenses are now widely commercially available due to industry involvement, trial sets are widely available, custom options are available for eyes requiring a larger diameter and a higher vault, and clinical education is available,” she said. Because of this work, interest in these lenses increased markedly. Meanwhile, Dr Jacobs and her colleagues in Boston, as well as groups at Mayo Clinic in Rochester, Minnesota, US, and University of California Davis, US, were achieving excellent outcomes in visual function and visual acuity in patients with keratoconus fitted with scleral lenses. Patients went along with the idea of surgery, expecting that a transplant meant a cure. Surgeons also argued that high K values would prevent fitting of the lenses, or that the presence of an axial scar would limit vision in a scleral lens. However, Dr Jacobs noted that her effort to enlighten surgeons about the benefits of scleral lenses was an uphill battle, with surgeons maintaining that the lenses were a “boutique technology” (i.e., expensive, labour-intensive and not readily available). She explained that once rigid gas-permeable scleral lenses were developed in the 1990s, she did not perform keratoplasty without first giving the patient the opportunity to have a trial with scleral lenses with innovator Dr Perry Rosenthal, in Boston, MA. In her practice, Dr Jacobs refers all patients with keratoconus who are not satisfied with spectacle or soft lens vision for scleral lenses. Keratoplasty should only rarely be performed.” Scleral lenses to the rescue “In addition, performing Descemet anterior lamellar keratoplasty is not advantageous regarding achieving decreases in postoperative astigmatism despite high expectations. “The truth is that the rate of astigmatism is high, in that it averages 4 D, and up to 40% of patients are contact lens-dependent,” she said. Dr Jacobs theorised that the patients are dissatisfied because they are comparing the outcomes with the eye that is less affected or they anticipated vision at the same level that they achieved with rigid gas-permeable contact lenses. In addition, despite good visual outcomes following penetrating keratoplasty, the vision-related quality of life is impaired in patients who have undergone bilateral procedures with resulting good vision in the better eye. ![]() The improvement … is inversely associated with visual acuity in the better-seeing eye (i.e., the good eye rules when the bad eye undergoes surgery),” said Dr Deborah Jacobs, associate professor of ophthalmology, Harvard Medical School, Boston, Massachusetts, United States. “The improvement in visual function does not correlate with the postoperative acuity in the grafted eye. Through these contract arrangements, eye care services are offered to you, and all other vision insurance plan participants, at discounted rates.Patients with keratoconus can generally undergo a successful corneal transplant surgery but nevertheless be unsatisfied with the outcomes because of high astigmatism. The majority of the time, eye care provider networks contract with vision insurance organizations. With vision benefits that are purchased directly from a vision insurance company, the plan will – more than likely – function like a PPO plan. With vision insurance that is added to an indemnity insurance plan, participants can typically use any provider they want.ĭid you purchase vision benefits directly from a vision insurance company? In-network providers are typically less expensive and – depending on your specific coverage and co-payment requirement – can be completely covered.Īre your vision benefits added on to an indemnity insurance plan? With vision insurance that is joined to a PPO (preferred provider organization), plan participants can usually utilize out-of-network providers, but at a greater cost. With an HMO (health maintenance organization), plan participants are usually required to obtain vision services only from in-network providers. ![]()
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