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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Scientific Journal of Pediatrics
Ariesanti Tri Handayani
Department of Ophthalmology, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Tear Reservoir Thickness and Vector-Resolved Refractive Outcomes in Indonesian Corneal Ectasia: A Scleral Lens Pilot Study Anak Agung Ayu Putri Prematura Sri Anasary; Ariesanti Tri Handayani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1512

Abstract

Background: Corneal ectasia is characterized by high-order aberrations and irregular astigmatism, presenting significant optical challenges. Scleral lenses neutralize these irregularities via a post-lens tear reservoir. However, the precise optical contribution of the tear reservoir thickness itself to residual refractive error remains under-characterized, particularly in Southeast Asian populations where aggressive ectasia phenotypes are common. This study aimed to determine if tear reservoir thickness correlates with residual refractive error using vector analysis. Methods: This retrospective pilot study analyzed 12 eyes of 8 patients with severe corneal ectasia fitted with scleral lenses in Indonesia. Refractive outcomes were converted to Thibos power vectors (M, J0, J45). To account for bilateral eye correlations, linear mixed models (LMM) were employed with Patient ID as a random effect. A theoretical thick-lens model compared predicted versus observed over-refraction. Results: The cohort (mean age 28 ± 10.2 years) achieved significant visual improvement (LogMAR 0.35 to 0.17; p = 0.005). The mean tear reservoir thickness was 263.33 ± 80.92 μm. LMM analysis revealed no statistically significant correlation between fluid thickness and Spherical Equivalent (M) (beta = -0.001, p = 0.72) or Blur Strength (p = 0.68). The theoretical model indicated that residual error was driven by uncorrected posterior corneal astigmatism rather than fluid depth. Conclusion: In this Indonesian cohort, optical efficacy was driven by refractive index matching at the corneal interface, not reservoir thickness. Clinical fitting should prioritize physiological clearance over refractive manipulation.
Tear Reservoir Thickness and Vector-Resolved Refractive Outcomes in Indonesian Corneal Ectasia: A Scleral Lens Pilot Study Anak Agung Ayu Putri Prematura Sri Anasary; Ariesanti Tri Handayani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1512

Abstract

Background: Corneal ectasia is characterized by high-order aberrations and irregular astigmatism, presenting significant optical challenges. Scleral lenses neutralize these irregularities via a post-lens tear reservoir. However, the precise optical contribution of the tear reservoir thickness itself to residual refractive error remains under-characterized, particularly in Southeast Asian populations where aggressive ectasia phenotypes are common. This study aimed to determine if tear reservoir thickness correlates with residual refractive error using vector analysis. Methods: This retrospective pilot study analyzed 12 eyes of 8 patients with severe corneal ectasia fitted with scleral lenses in Indonesia. Refractive outcomes were converted to Thibos power vectors (M, J0, J45). To account for bilateral eye correlations, linear mixed models (LMM) were employed with Patient ID as a random effect. A theoretical thick-lens model compared predicted versus observed over-refraction. Results: The cohort (mean age 28 ± 10.2 years) achieved significant visual improvement (LogMAR 0.35 to 0.17; p = 0.005). The mean tear reservoir thickness was 263.33 ± 80.92 μm. LMM analysis revealed no statistically significant correlation between fluid thickness and Spherical Equivalent (M) (beta = -0.001, p = 0.72) or Blur Strength (p = 0.68). The theoretical model indicated that residual error was driven by uncorrected posterior corneal astigmatism rather than fluid depth. Conclusion: In this Indonesian cohort, optical efficacy was driven by refractive index matching at the corneal interface, not reservoir thickness. Clinical fitting should prioritize physiological clearance over refractive manipulation.
Linking Corneal Remodelling to Axial Growth: Induced Peripheral Myopic Defocus and Slow Axial Elongation During 23 Months of Orthokeratology in a 10-Year-Old Girl Aprilia Elisabet; Ariesanti Tri Handayani; I Gusti Ayu Made Juliari; Surya Ari Wahyudi
Scientific Journal of Pediatrics Vol. 4 No. 1 (2026): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v4i1.319

Abstract

Background: Childhood myopia is the commonest chronic eye disorder of school age, and its harm is carried by axial elongation rather than by blur. Orthokeratology reshapes the cornea overnight into an oblate profile that corrects central vision while imposing myopic defocus on the peripheral retina, but the mechanism is rarely measured in the same child in whom the outcome is measured. Objective: To describe the optical mechanism, corneal remodelling, safety, and axial elongation during 23 months of overnight orthokeratology in a 10-year-old girl with progressive myopia. Case presentation: A paediatric case was followed clinically for 23 months. Serial corneal topography, zonal refractometry, visual acuity, ocular examinations, and optical biometry were assessed. Reshaping was complete by day 26: central axial power fell from 45.60 D to 43.24 D in the right eye and from 45.67 D to 42.78 D in the left, and corneal asphericity reversed from prolate (Q −0.10 and −0.22) to markedly oblate (Q +0.94 and +0.93). Relative peripheral refraction at the 5 mm chord shifted from −0.62 D to −2.12 D in the right eye and from −0.63 D to −2.13 D in the left, corresponding to induced relative peripheral myopic defocus of −1.50 D per eye. Axial length rose by 0.10 mm and 0.11 mm between months 16 and 23, approximately 0.17 and 0.18 mm per year. A transient punctate epitheliopathy at month 11 resolved without interrupting treatment. Conclusion: Overnight orthokeratology produced durable corneal remodelling and peripheral myopic defocus, with slow axial elongation and a reversible minor epithelial event in this child. Baseline axial-length measurement remains essential for treatment monitoring.
Co-Authors Anak Agung Ayu Putri Prematura Sri Anasary Aprilia Elisabet I Gusti Ayu Made Juliari Surya Ari Wahyudi