Using contact lenses to steepen the cornea post surgery

Much like the shine of a new car or the crispness of a new pair of shoes, new always seems better than a retread. Our profession is no different, especially when it comes to new technologies and the modern design of frames.

New or modern may not always be in the patient’s best interest when what has worked for years and adding a current flair may work as well. You need look no further than the nerdy-chic style or the more modern upgrades to the phoropter. Sometimes no change is needed to something that has worked effectively and flies under the radar.

I am writing this to impart clinical acumen that I learned years ago-contact lens-associated pharmacologically induced kerato steepening or CLAPIKS. I was recently consulted on a case that would have benefitted from some CLAP(iks) back from the managing doctor.

Previously from Dr. Bloomenstein: Managing presbyopia with evolving inlay technology

Understanding CLAPIKS

Imagine you are following a myopic patient who recently underwent a corneal refractive procedure. His scans looked perfect, the thickness was ideal, there was no inflammatory keratitis, all in all a smooth surgery. Yet, he cannot see well at near. Your placid surgical postop patient has a hyperopic correction, indicating he is an over responder. CLAPIKS!

That tiny voice is now asking, “What is he talking about? CLAP-what?”

Related: New correction option for presbyopes

If you lived in the Fayetteville, AR area, then this acronym should not be a surprise. Jay McDonald II, MD, and Allyson Mertins, OD, successfully treated hyperopic over responders following LASIK with the use of CLAPIKS.¹ The goal was to provide a more permanent treatment to the incipient hyperopia that some LASIK patients were now enduring.

CLAPIKS is based on keratocyte thickening and thus reshaping a slightly flatter cornea to a steeper profile. The pharmacology involved in this treatment is a non-steroidal anti-inflammatory (NSAID) over a steep contact lens.

The CLAPIKS technique is dependent on both the amount of over response and patient reported symptoms. This treatment option is best suited for patients who have an over response greater than 1.00 D.

I try to use this technique within the first week of surgery and will often use a contact lens that is slightly hyperopic. The original technique specifies that any soft disposable lens is acceptable, although a high Dk lens is not desirable.¹

This contact lens will be worn on an extended wear basis and the use of a NSAID, such as ketorolac (Acular LS, Allergan) should be used qid. The patient should continue the use of artificial tears along with Acular LS and wearing the contact lens.

Related: Managing LASIK complications

Be patient with CLAPIKS

The concept of remolding the cornea shape is predicated on the contact lens as a mold and the keratocyte growth initiated from the Acular LS. I will follow the patient in the office weekly to over-refract and check his progress. Wearing the contact lens on an extended-wear basis is important, so I try to keep the lens in for as long as it is optically clear. Should you need to replace the contact lens, no need to worry that replacement will reverse the progress made.

The CLAPIKS technique may take weeks to find its footing, but because the patient is able to see, he is more likely to keep up the regimen. Once you establish a good Rx for the patient, bring him back for another visit to ensure he has a consistent refractive error. If the patient is content and the vision checks out well, you can claim a CLAPIKS miracle.

The over response of LASIK patients is not a common event, but it does happen. CLAPIKS provides a straightforward and practical approach to help patients through this healing period. If it doesn’t work, you have at the very least given the patient better vision between treatment options.

Reference

1.McDonald JE 2nd, Mertins A, Deitz D. Contact lens assisted pharmacologically induced keratoshaping. Eye Contact Lens. 2004 Jul;30(3):122-6.

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