Achint Kaur, B. Optom
Optometrist, Amity University, Haryana, India
“Graft” refers to transplanted or donor tissue and “Host” refers to the tissue of the recipient, thus Graft-versus-Host Disease (GVHD) is a systemic disorder that occurs when graft immune system cells perceive the host as a foreign and start attacking the donor’s body cells. GVHD results from an overactive inflammatory response that destroys normal host tissue.
Ocular GVHD is associated with the following signs:
- Meibomian gland obstruction
- Anterior/posterior blepharitis,
- Less tear production
- Conjunctival hyperaemia with pseudo membrane formation.
- Prolonged inflammation can lead to conjunctival necrosis, cicatricial scarring, and fibrosis
- Corneal manifestations include:
- Punctate epithelium keratoplasty
- Filamentary keratitis
- Corneal erosions
These patients suffer from symptoms like ocular pain, blurring of vision, foreign body sensation, irritation photophobia, dryness, burning sensation, and most importantly by these symptoms decreased quality of life. GVHD patients are at risk of long-term immunosuppression and delayed healing. (1) These patients have undergone various treatment methods, including artificial tears, steroids, cyclosporine, antibiotics, and autologous serum (blood-derived eye drops), to treat the symptoms. Despite such treatable approaches some patients still felt unrelieved and suffered.(2)
Figure 1: Scleral Lens (image captured by Author)
For such patients, it has been viewed that scleral lenses provide more benefits. Scleral lenses act as a therapeutic tool for the treatment of ocular surface disease as these lenses protect the ocular surface, give hydration to the cornea, and provide good visual corrections.(3)
The Scleral lens in Current Ophthalmic Practice Evaluation (SCOPE) study groups reported that about 74% of scleral lenses used for corneal irregularity, 16% for ocular surface, and 10% for uncomplicated refractive error. More than 80% of scleral lens prescribers reported fitting their first lens after 2005 and >54% after 2010.(4)
This increase has been noted due to advancements in contact lenses and the revolution in technology and education. Drug therapy by scleral lens encourages the healing of surface epitheliopathy while improving pain and photophobia associated with ocular graft versus host disease.(1) The working is very simple as these lenses sit on the sclera and vault over the eye, with a chamber of saline solution filling the chamber between the eye and the lens. This design helps to keep the eyes hydrated and lubricated while the lenses are worn. The fluid reservoir that scleral lenses hold helps to continuously bathe the anterior ocular surface, acting like a liquid Band-Aid, and thus helps in a speedy recovery providing patients with better vision.
Conclusions: Scleral lenses are one such treatment or strategy that has been found to provide both symptomatic relief and ocular surface protection to patients suffering from GVHD. (5)
- Schornack MM, Baratz KH, Patel SV, Maguire LJ. Jupiter scleral lenses in the management of chronic graft versus host disease. Eye Contact Lens. 2008; 34:302–305.
- Ogawa Y, Okamoto S, Mori T, et al. Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease. Bone Marrow Transplant. 2003; 31:579–583.
- Harthan JS, Shorter E. Therapeutic uses of scleral contact lenses for ocular surface disease: patient selection and special considerations. Clin Optom (Auckl). 2018; 10:65-74.
- Nau CB, Harthan J, Shorter E, et al. Demographic characteristics, and prescribing patterns of scleral lens fitters: the SCOPE study. Eye Contact Lens. Epub 2017 Jun 14.
- Balasubramaniam, Saranya C. M.D.; Raja, Harish M.D.; Nau, Cherie B. O.D.; Shen, Joanne F. M.D.; Schornack, Muriel M. O.D.. Ocular Graft-Versus-Host Disease: A Review. Eye & Contact Lens: Science & Clinical Practice: September 2015 – Volume 41 – Issue 5 – p 256-261