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Lee and Jung: Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens
Original Article

J Korean Ophthalmol Soc 2016;57(4):546-554.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.546

Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens

Kang Won Lee, MD, Ji Won Jung, MD

Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea

Address reprint requests to Ji Won Jung, MD Department of Ophthalmology, Inha University Hospital, #27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: 82-32-890-2400, Fax: 82-32-890-2417 E-mail: panch325@hanmail.net

Received 26 November 2015       Revised 7 January 2016       Accepted 8 March 2016

Copyright © 2016 The Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material.

Methods

The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer's test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality.

Results

TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p = 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p = 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p = 0.001, p < 0.001).

Conclusions

Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers.

Keywords: Meibomian gland dysfunction, Ocular surface status, Orthokeratologic lens, Rigid gas permeable lens

References

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Figure 1.
Comparison of changes in ocular surface parameters after 3 months of lens use between the orthokeratologic (OK) lens group and rigid gas permeable (RGP) lens group: ocular surface disease index (OSDI) (A), Schirmer I score (B), tear break-up time (TBUT) (C), and ocular surface staining score (D). *For changes from baseline to 1 and 3 months of use between the two groups, using repeated-measures analysis of variance (ANOVA) incorporating, where necessary, a Greenhouse-Geisser correction for non-sphericity; †Using a Mann Whitney test to compare the changes between the two groups.
jkos-57-546f1.tif
Figure 2.
Comparison of changes in meibomian gland parameters after 3 months of lens wearing in the orthokeratologic (OK) lens group and rigid gas permeable (RGP) lens group: meibomian gland dysfunction (MGD) grade (A), lid margin abnormality (B), meibomian gland expressiblility (C), and meibum quality (D). *For changes between baseline and 1 and 3 months of use between the two groups, using repeated-measures analysis of variance (ANOVA) incorporating, where necessary, a Greenhouse–Geisser correction for non-sphericity; †Generalized estimating equations model for noncontinuous scale values: MGD stage, n (%, proportion ≥ stage 2); Lid margin abnormality, n (%, proportion of ≥2); Meibomian gland expressibility, n (%, proportion of ≥1).
jkos-57-546f2.tif
Figure 3.
Changes in ocular surface status in a 17-year-old female who wore an rigid gas permeable (RGP) lens. Increased ocular surface staining was noted before (A) and after 3 months (B; arrows) of RGP lens use. Comparing to baseline (C), meibomian gland plugging and vascular engorgements were developed after 3 months of RGP lens use (D; arrows).
jkos-57-546f3.tif
Table 1.
Characteristics of the rigid contact lenses used in this study
Parameters OK lens RGP lens
Material Boston XO® (Hexafocon A) Boston XO® (Hexafocon A)
Brand Contex OK® Boston SuperVision® II
Overall diameter (mm) 9.5∼11.5 8.9∼9.5
Optic zone diameter (mm) 5.5∼6.5 7.5∼8.1
EOP (%) 18 18
Dk* 100 140
Powers (diopter) −0.50-7.50 −20.00∼+20.00

OK = orthokeratologic; RGP = rigid gas permeable; EOP= equivalent oxygen percentage; Dk =diffusion coefficient.

* 10-11 cm2/sec (mL · O2/[mL·mm Hg]).

Table 2.
Demographic characteristics of the subjects in this study
OK lens group RGP lens group p-value*
Number of eyes 12 16
Gender (male/female) 2/10 2/14
Age (years) 19.3 ± 7.1 21.5 ± 5.5
 Median (range) 19 (11-30) 21 (12-30) 0.371
Corneal astigmatism (D) 0.93 ± 0.46 2.05 ± 0.59
 Median (range) 0.81 (0.5-1.75) 2.00 (1.00-3.37) <0.001
Mean keratometric value (D) 42.39 ± 2.32 43.27 ± 1.13
 Median (range) 42.93 (37.50-44.63) 43.18 (41.12-44.95) 0.443
Refractive SE (D) −2.82 ± 0.63 −5.16 ± 2.38
 Median (range) −2.94 (-1.88∼-3.94) −5.16 (-1.13∼-10.10) 0.006

Values are presented as mean ± SD unless otherwise indicated.

OK = orthokeratologic; RGP = rigid gas permeable; SE = spherical equivalent.

* Mann-Whitney test.

Table 3.
Comparison of baseline ocular surface status between OK lens and RGP lens groups
OK lens group RGP lens group p-value*
Ocular surface parameters
 Subjective score (OSDI) 16.93 ± 12.17 21.49 ± 14.31
  Median (range) 15.84 (0.00-39.58) 18.75 (0.00-47.50) 0.260
 Schirmer's test value (mm) 28.33 ± 5.37 20.31 ± 10.40
  Median (range) 30 (20-35) 20 (5-35) 0.052
 TBUT (seconds) 8.92 ± 1.78 8.06 ± 2.38
  Median (range) 10 (5-10) 10 (5-10) 0.450
 Ocular surface staining score (DEWS score, 0-33) 0.83 ± 1.59 1.75 ± 2.18
  Median (range) 0 (0-4) 0 (0-6) 0.347
Evaluation of meibomian gland
 MGD grade (n, %)† 0 (0) 0 (0) > 0.999
 Lid margin abnormality (n, %)† 0 (0) 0 (0) > 0.999
 Meibomian gland expressibility (n, %)† 4 (33.3) 8 (50.0) 0.051
 Meibum quality (0-24) 0.50 ± 0.79 1.25 ± 1.00
  Median (range) 0 (0-2) 2 (0-2) 0.082

Values are presented as mean ± SD unless otherwise indicated.

OK = orthokeratologics; RGP = rigid gas permeable; OSDI = ocular surface disease index; TBUT = tear break-up time; DEWS = dry eye workshop; MGD = meibomian gland dysfunction.

* Mann-Whitney test;

† Generalized estimating equations model for noncontinuous scale values: MGD stage, n (%, proportion ≥ stage 2); lid margin abnormality, n (%, proportion of ≥2); meibomian gland expressibility, n (%, proportion of ≥1).

Table 4.
Changes in ocular surface status and meibomian gland parameters in the OK lens group
Parameters Before (baseline) 1 month 3 months p-value* p-value†
Before vs. 1 month Before vs. 3 months
Ocular surface parameters
 Subjective score (OSDI) 16.93 ± 12.17 18.31 ± 11.69 19.86 ± 14.71
  Median (range) 15.84 (0.00-39.58) 15.63 (9.09-14.70) 16.88 (2.08-47.90) 0.267 0.180 0.208
 Schirmer's test value (mm) 28.33 ± 5.37 25.08 ± 7.05 26.33 ± 3.26
  Median (range) 30 (20-35) 29 (9-30) 28 (21-30) 0.155 0.072 0.166
 TBUT (seconds) 8.92 ± 1.78 6.17 ± 3.71 5.75 ± 2.80
  Median (range) 10 (5-10) 7 (0-10) 6 (2-9) 0.004 0.021 0.006
 Ocular surface staining score (0-33), Oxford 0.83 ± 1.75 2.17 ± 2.08 2.83 ± 2.17
  Median (range) 0 (0-4) 2 (0-6) 2 (0-7) <0.001 0.021 0.009
Evaluation of meibomian gland
 MGD grade (n, %)‡ 0 (0) 2 (16.7) 4 (33.3) <0.001 0.001 <0.001
 Lid margin abnormality (n, %)‡ 0 (0) 2 (16.7) 5 (41.7) <0.001 <0.001 <0.001
 Meibomian gland expressibility (n, %)‡ 4 (33.3) 9 (75.0) 10 (83.3) <0.001 0.001 <0.001
 Meibum quality (0-24)* 0.50 ± 0.79 2.00 ± 1.04 2.83 ± 1.26
  Median (range) 0 (0-2) 2 (1-4) 2 (2-5) 0.002 0.006 0.018

Values are presented as mean ± SD unless otherwise indicated.

OK = orthokeratologic; OSDI = ocular surface disease index; TBUT = tear break-up time; MGD = meibomian gland dysfunction.

* Using repeated-measures analysis of variance (ANOVA) incorporating, where necessary, a Greenhouse-Geisser correction for non-sphericity;

† Post-hoc analysis using a Wilcoxon Signed-Rank test;

‡ Generalized estimating equations model for noncontinuous scale values: MGD stage, n (%, proportion > stage 2); lid margin abnormality, n (%, proportion of ≥2); meibomian gland expressibility, n (%, proportion of ≥1).

Table 5.
Changes in ocular surface status and meibomian gland parameters in the RGP lens group
Parameters Before (baseline) 1 month 3 months p-value* p-value†
Before vs. 1 month Before vs. 3 months
Ocular surface parameters
 Subjective score (OSDI) 21.49 ± 14.31 24.57 ± 12.45 30.57 ± 16.03
  Median (range) 18.75 (0.00-47.50) 15.63 (9.09-39.58) 33.54 (2.08-47.90) <0.001 0.100 0.009
 Schirmer's test value (mm) 20.31 ± 10.40 22.31 ± 7.53 23.44 ± 6.51
  Median (range) 20 (5-35) 25 (10-30) 27 (11-29) 0.104 0.274 0.078
 TBUT (seconds) 8.06 ± 2.38 5.44 ± 2.22 3.50 ± 1.93
  Median (range) 10 (5-10) 6 (3-9) 4 (0-6) <0.001 <0.001 <0.001
 Ocular surface staining score (0-33), Oxford 1.75 ± 2.18 3.88 ± 2.25 5.31 ± 3.48
  Median (range) 0 (0-6) 3 (1-6) 4 (2-11) <0.001 0.003 <0.001
Evaluation of meibomian gland
 MGD grade‡ 0 (0) 8 (50.0) 14 (87.5) <0.001 <0.001 <0.001
 Lid margin abnormality‡ 0 (0) 10 (62.5) 13 (81.3) <0.001 <0.001 <0.001
 Meibomian gland expressibility (n, %)‡ 10 (62.5) 15 (93.8) 16 (100) <0.001 <0.001 <0.001
 Meibum quality (0-24)* 1.25 ± 1.00 5.25 ± 3.22 6.63 ± 2.53
  Median (range) 2 (0-2) 3 (1-9) 6 (2-9) <0.001 <0.001 <0.001

Values are presented as mean ± SD unless otherwise indicated.

RGP = rigid gas permeable; OSDI = ocular surface disease index; TBUT = tear break-up time; MGD = meibomian gland dysfunction.

* Using repeated-measures analysis of variance (ANOVA) incorporating, where necessary, a Greenhouse-Geisser correction for non-sphericity;

† Post-hoc analysis using a Wilcoxon Signed-Rank test;

‡ Generalized estimating equations model for noncontinuous scale values: MGD stage, n (%, proportion > stage 2); lid margin abnormality, n (%, proportion of ≥2); meibomian gland expressibility, n (%, proportion of ≥1).

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