Importancia del perfil de superficie corneal, en adaptación de lentes RGP corneales
Por: Joaquín Guerrero Vargas OD. | MgS. Tecnologías Accesibles y escritor.
joguero@hotmail.com
La comprensión integral de la superficie ocular en contactología, supone la asimilación geométrica y abstracción de la unidad anatómica corneo escleral desde un plano de análisis tridimensional, en el cual, las áreas concéntricas corneales, los mapas de elevación por zonas o cuadrantes, sus diferencias antero posteriores y la paquimetría corneal, son variables que conjuntamente representan la forma corneal apta para una adaptación de lentes de contacto, además de su progresión temporal e implicaciones que esto supone para las fases contactológicas posteriores.
Esto sin contar la introducción del estudio topográfico escleral en las adaptaciones más complejas de lentes esclerales con hápticas tóricas, en los cuales la naturaleza de diseño del lente supone per se la corrección de condiciones topográficas que eventualmente rebasan el límite corneal, y suponen un mayor reto para el adaptador en cuanto a la necesidad de estudiar la forma escleral como requisito para concretar la adaptación de los lentes de gran diámetro.
En todo caso, la casuística de irregularidades corneales podría agruparse desde el análisis de dos variables fundamentales: el área topográfica comprometida, y la pendiente de la misma; la primera entendida como el área comprendida entre los valores escalares que conforman la base ectásica o zona de incurvamiento corneal (tonos topográficos cálidos), hasta la queratometría más pronunciada o correspondiente a la zona ectásica o con mayor altura sagital, mientras que la pendiente se analizaría como la angulación entre los valores “piso y techo” de la queratometría en la zona ectásica circunscrita al área topográfica afectada.
En este sentido las áreas de “compromiso topográfico” podrían definirse en sus casos extremos como pequeñas y grandes, aludiendo a zonas que caben en un cuadrante y aquellas que ocupan el menos dos o tres de ellos en forma respectiva, mientras que la pendiente podría estudiarse como alta y baja, cuando en forma respectiva se producen grandes cambios en la asfericidad, del orden de 5 o más dioptrías en pequeñas áreas corneales, o cuando el mismo cambio de curvatura se distribuye en zonas corneales aún más amplias, dando lugar a un aplanamiento menos pronunciado que favorece en muchos casos la escogencia de diseño y adaptación de un lente RGP corneal.
Con el advenimiento de la fabricación de lentes de contacto mediante tornos de control numérico, la industria ha permitido crear superficies de curva base y cara anterior con asfericidad controlada, incluso para adaptar lentes RGP corneales en ectasias de alta pendiente y altura sagital, en las que se aplican curvas base que desde una altura sagital considerable generan rápidos cambios de excentricidad y aplanamiento (alta asfericidad) aplicable aun a reducidas zonas ópticas del lente, que proveen mejores resultados en ectasias pequeñas con alta protrusión corneal.
De la misma forma, esta tecnología permite crear el mismo grado de asfericidad del primer ejemplo en zonas más amplias de la curva base, generando pendientes menos pronunciadas que favorecen la adaptación, centraje y movimiento en corneas con mayores áreas topográficos comprometidas por la ectasia.
Estos avances en la producción de lentes de contacto rígidos, ha proveído durante la última década una nueva visión en la adaptación de lentes de contacto, nunca antes satisfecha de manera plena por los lentes asféricos, multicurvos o primeros diseños de baja asfericidad que incursionaron en la práctica clínica. En tal sentido, la personalización de diseño de curvas elípticas e hiperbólicas guiadas por topografía corneal y mapas de elevación, ha llevado la adaptación de lentes rígidos a un nivel sin precedentes, en el que incluso el tamaño de las ectasias ni su pendiente, representan una limitante para la generación de curvas altamente perfiladas para cada paciente, en las que la adaptación, el fluorograma y los resultados refractivos han adquirido un nivel de perfeccionamiento un mayor del que otrora permitieran los diseños de curva anteriormente mencionados.
Gabriel Merchán de Mendoza, o un sinónimo de Optometría.
Hacer una semblanza del doctor Merchán es una oportunidad tan invitadoras...Ver mas
Efecto sobre la presión intraocular posterior a una hora de uso, en usuarios con lentes de contacto esclerales. Una de las principales precauciones... .Ver mas
Biomecánica corneal y sus métodos actuales de evaluación.
La biomecánica básicamente se refiere a la forma mecánica en que funciona nuestro cuerpo...Ver mas
Efecto sobre la presión intraocular posterior a una hora de uso, en usuarios con lentes de contacto esclerales. Una de las principales precauciones... .Ver mas
Gabriel Merchán de Mendoza, o un sinónimo de Optometría.
Hacer una semblanza del doctor Merchán es una oportunidad tan invitadoras...Ver mas
Biomecánica corneal y sus métodos actuales de evaluación.
La biomecánica básicamente se refiere a la forma mecánica en que funciona nuestro cuerpo...Ver mas
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