title: Corneal nerve structure and function after long-term wear of fluid-filled scleral lens.
abstract: OBJECTIVE
  The aim of this study was to determine whether long-term wear of a fluid-filled scleral lens alters basal tear production, corneal sensation, corneal nerve density, and corneal nerve morphology in 2 disease categories.
  
  
  METHODS
  Patients recruited from the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment program at the Weill Cornell Medical College were categorized into 2 groups: distorted corneas (DC) or ocular surface disease (OSD). We measured tear production, central corneal sensation, subbasal nerve density and tortuosity, and stromal nerve thickness before and after long-term wear of the prosthetic device used in PROSE treatment, defined as at least 60 days of wear for a minimum of 8 hours a day.
  
  
  RESULTS
  Twenty patients were included in the study. After long-term wear of the prosthetic device, tear production decreased in patients with DC (21.2 ± 8.5 to 10.4 ± 4.6 mm; P < 0.0001) but did not change in patients with OSD (7.5 ± 5.2 to 8.7 ± 7.2 mm; P = 0.71). Corneal sensation increased in the DC group (45.6 ± 9.2 to 55.0 ± 5.6 mm; P < 0.05). There was no significant change in sensation in patients with OSD (45.0 ± 8.7 to 49.1 ± 14.8 mm; P = 0.37). Subbasal nerve density, subbasal nerve tortuosity, and stromal nerve thickness remained unchanged in both DC and OSD groups after long-term wear (P > 0.05).
  
  
  CONCLUSIONS
  Patients with DC had significantly reduced basal tear production and increased corneal sensation after long-term wear of the scleral lens, but patients with OSD did not show any changes in tear production or corneal sensation.
authors.affiliation: *Department of Ophthalmology, Weill Cornell Medical College, New York, NY; and †Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Wang
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Kornberg
authors.forename: Ryan M
authors.initials: RM
authors.lastname: St Clair
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Irma
authors.initials: I
authors.lastname: Muhic
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Ciralsky
authors.forename: Ana
authors.initials: A
authors.lastname: Alzaga Fernandez
authors.forename: Priyanka
authors.initials: P
authors.lastname: Sood
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Sippel
authors.forename: Mark I
authors.initials: MI
authors.lastname: Rosenblatt
mesh_terms: D001705:Bioprosthesis / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003261:Contact Lenses; D003315:Cornea / Q000294:innervation* / Q000503:physiopathology; D015352:Dry Eye Syndromes / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006086:Graft vs Host Disease / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009882:Ophthalmic Nerve / Q000503:physiopathology*; D011446:Prospective Studies; D012590:Sclera; D013262:Stevens-Johnson Syndrome / Q000503:physiopathology / Q000628:therapy; D013666:Tears / Q000502:physiology