Use of Acular LS in the pain management of keratoconus: a pilot study.

Author(s): Yu JO, Gundel RE

Affiliation(s): Clinical Sciences, Contact Lens Research Group, SUNY State College of Optometry, New York, New York, USA. jessicayuod@gmail.com

Publication date & source: 2010-02, Optom Vis Sci., 87(2):125-30.

Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

PURPOSE: The purpose of this pilot study was to determine the efficacy of ketorolac tromethamine 0.4% for pain management in conjunction with rigid gas permeable contact lenses in keratoconus. Any potential side effects and complications of this application were examined. METHODS: A total of 12 current keratoconus patients who were presently experiencing discomfort or pain associated with their rigid gas permeables for keratoconus and/or who were contact lens-intolerant were identified from the existing patient population at the SUNY University Optometric Center. Symptomatic subjects were identified through positive feedback to a study Inclusion Questionnaire mailed to their homes. Subjects were treated on the basis of each eye separately in a modified monocular trial that spanned 5 weeks. After establishing that all inclusion and exclusion criteria were met, subjects were instructed to first use an unlabeled bottle of artificial tear solution (placebo) for 2 weeks, and then an unmarked bottle of ketorolac tromethamine 0.4% for 2 weeks in the designated eye. One drop was instilled twice a day, and the eye not assigned to take the drops served as the control. Subjects were monitored through weekly follow-up visits and repeated Keratoconus Symptom and Severity Questionnaires. RESULTS: Responses from the Keratoconus Symptom and Severity Questionnaire were analyzed using a 2-factor Repeated Measures Analysis of Variance. Among the small subject subset, there was no statistically significant predilection for the ketorolac tromethamine 0.4% in managing the discomfort and pain associated with keratoconus. The artificial tear solution appeared to be equally effective in improving comfort. CONCLUSIONS: There was no conclusive result as to the efficacy of the ketorolac tromethamine 0.4% vs. the artificial tear solution in the pain management of keratoconus. This could be attributed to a number of physiological and situational factors, as well as small sample size.