Peter R. Kastl, MD, PhD
1. Ford MC, Kastl PR. Contact lens articles in the literature: an update. CLAO Journal. 1998;24:152-4.
PURPOSE: To determine if the pattern of publication of contact lens articles in the ophthalmic literature has changed in recent years. METHODS: We searched the literature of the past 5 years and reviewed the abstracts of all published papers that presented information on contact lenses. The journals reviewed included the American Journal of Ophthalmology, Archives of Ophthalmology, Ophthalmology, and The CLAO Journal. We determined whether articles were positive, negative, or neutral. RESULTS: We reviewed a total of 1,189,451 articles and 48,811 (4.10%) eye articles; of the latter, 987 (2.02%) discussed contact lenses. Only 86 total contact lens articles were published in the three major ophthalmology journals, of which almost 40% presented negative information (e.g., complications of contact lens usage). The CLAO Journal published 136 contact lens articles during the same time period (39.7% were positive and 30.1% were negative). CONCLUSIONS: In the past 5 years, fewer contact lens articles have appeared in the ophthalmic literature than had appeared in the previous five years, and, in addition, more of these articles were negative. The CLAO Journal continues to publish the largest number of contact lens articles, although the percentage of positive articles has decreased somewhat, from 50% to 39.7%.
2. Lee AM, Kastl PR. Rigid gas permeable contact lens fitting after radial keratotomy. CLAO Journal. 1998;24:33-5.
PURPOSE: The purpose of our study was to determine whether radial keratotomy (RK) patients could be fit with rigid gas permeable (RGP) contact lenses based on postoperative keratometry measurements. METHODS: Thirteen eyes from eight post-RK patients were fit with RGP lenses for residual refractive errors. Since these patients were self-referred and were operated on elsewhere, preoperative keratometry readings were not available. We used postoperative keratometry readings for base curve selection; and spherical polymethylmethacrylate diagnostic lenses were used for fitting. RESULTS: Visual improvements averaged 3.85 Snellen lines (range: 1-8 lines). Prefitting visual acuities were: 20/30 (5 eyes); 20/40 (1 eye); 20/ 50 (1 eye); 20/60 (1 eye); 20/70 (3 eyes); 20/150 (1 eye); and 20/200 (1 eye). Final visual acuities were 20/20 (7 eyes), 20/25 (4 eyes), 20/30 (1 eye), and 20/40 (1 eye). CONCLUSION: We found that when fitting post-RK eyes with RGP contact lenses preoperative keratometry was unnecessary, and an empirical fitting method based on postoperative keratometry was successful.
3. Cole HP, Couvillion JT, Fink AJ, Haik BG, Kastl PR. Exophthalmometry: a comparative study of the Naugle and Hertel instruments. Ophthalmic Plastic & Reconstructive Surgery. 1997;13:189-94.
Exophthalmometry is frequently used as a tool in the evaluation of proptosis. The purpose of this study was to compare the clinical usefulness of the newly developed Naugle superior and inferior orbital rim-based exophthalmometer with that of the Hertel exophthalmometer, as well as to obtain normal values and analysis of possible race and sex differences. In the first part of this study, we measured 135 patients in a double-blind study in order to evaluate the repeatability of serial measurements using each instrument. Comfort was also evaluated in this series of patients. In the second part, a single observer measured 205 patients in order to obtain information for a multifaceted analysis. In the first part of the study, we found the Hertel measurement to be more variable in terms of coefficients of variation. We further found the Hertel base measurements to vary more between observers than those of the Naugle instrument. In the second part, we found that the mean values of globe position were not statistically different (mean Naugle, 17.23; mean Hertel, 18.61; p = 0.909). A significant difference was noted between black and white patients when using the Naugle instrument. A difference between white and black women was noted with the Hertel instrument. The results of this analysis strongly suggest that the values obtained from the Naugle exophthalmometer are more repeatable in serial measurements compared with the Hertel values. However, single measurements of globe position from all patients were statistically similar. We conclude that the Naugle instrument is comparable in accuracy to the Hertel instrument for measuring ocular position, as well as being more comfortable for the patient. The Naugle instrument has the advantage of measuring hyperophthalmos and hypoophthalmos with a vertical gradient scale.
4. Jong KY, Kastl PR. Bausch & Lomb CW 79 aphakic extended wear contact lens: long-term follow-up. CLAO Journal. 1997;23:78-80.
PURPOSE: The purpose of our study was to assess the long-term tolerance of aphakic contact lenses in an elderly male population. METHODS: We conducted a follow-up study of Bausch & Lomb CW 79 aphakic extended wear contact lenses fit since 1982. A total of 109 patients (115 eyes) were identified. Records of 37 patients (43 eyes) were available to determine the course of contact lens wear. RESULTS: Thirty-six eyes were contact lens dropouts. The average time to failure was 22 months. Seventeen eyes from the failure group elected to receive secondary intraocular lenses (IOLs). Seven eyes were still wearing CW 79 contact lenses at the conclusion of the study. The average length of wear in these seven eyes was 91 months. CONCLUSIONS: We concluded that the CW 79 aphakic extended wear contact lenses were successful in selected cases. However, a high failure rate was found on long-term follow-up, and approximately half of the failure were converted to secondary IOLs.
5. Gonce MA, Kastl PR. Bitoric rigid contact lens with prism fitting in rare cases of moderate corneal and residual astigmatism. CLAO Journal. 1994;20:176-8.
We reviewed all records of bitoric rigid gas permeable (RGP) contact lenses with prism ballast fittings performed at Tulane University Hospital and affiliated clinics from 1985 to 1993. We found eight eyes of six patients fit were fit with this lens, which is indicated for the patient with a moderately astigmatic cornea in addition to residual refractive astigmatism. In this design, a small amount of prism is added to a standard bitoric design to achieve rotational stability. All patients achieved 20/25 or better vision. We provide an outline for fitting bitoric RGP contact lenses with prism ballast.
6. Leidenix MJ, Lundergan MK, Pfister D, et al. Perforated bacterial corneal ulcer in a radial keratotomy incision secondary to minor trauma [letter]. Archives of Ophthalmology. 1994;112:1513-4.
7. Maehara JR, Kastl PR. Rigid gas permeable extended wear. [Review] [36 refs]. CLAO Journal. 1994;20:139-43.
We have reviewed the pertinent literature on rigid gas permeable (RGP) extended wear contact lenses, and we discuss the benefits and adverse reactions of this contact lens modality, drawing conclusions from reviewed studies. We suggest parameters for success with these lenses and guidelines for the prevention of adverse reactions. [References: 36].
8. Kastl PR, Dell SJ. Contact lens articles in the literature. CLAO Journal. 1992;18:193-6.
We searched the ophthalmic literature of the past 5 years looking for patterns in the publication of contact lens articles. Contact lens articles constituted 2.59% of all ophthalmology articles. We found that a substantial percentage of the articles published in The CLAO Journal and selected optometric journals concerned contact lenses; this, however, was not the case with the major ophthalmology journals (American Journal of Ophthalmology [AJO], Ophthalmology, and Archives of Ophthalmology [Archives]). One recent contact lens development, disposable lenses, was covered by both The CLAO Journal and the major ophthalmology journals, but the coverage differed in that the orientation of the articles in the major ophthalmology journals was essentially negative. Articles about another recent development (rigid gas permeable contact lenses for extended wear), although found in The CLAO Journal, could not be found in the other ophthalmology journals. Finally, when the abstracts of all contact lens articles were reviewed, we found a negative slant to articles published in AJO and Archives. We believe that the major ophthalmology journals present a rather negative view of contact lenses; this, we think, impedes unbiased dissemination of information about new contact lens developments.
9. Kastl PR. Rigid versus soft contact lenses. International Ophthalmology Clinics. 1991;31:17-24.
10. Stonecipher KG, Jensen HG, Kastl PR, Faulkner A, Rowsey, JJ. Ocular infections associated with Comamonas acidovorans. American Journal of Ophthalmology. 1991;112:46-9.
Comamonas acidovorans (Pseudomonas acidovorans) is a ubiquitous gram-negative rod. Although generally considered nonpathogenic, we found C. acidovorans to be associated with six cases of ocular infections. The organism was the only isolate in three cases, whereas an association of other organisms was present in three cases. The multiple resistance patterns of these strains to antibiotic susceptibility testing emphasizes the need for culturing ocular infections. We recommend the identification and susceptibility testing of all ocular gram-negative rod isolates.
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