McDonald, an ophthalmologist in Little Rock, Ark., developed the
treatment Contact Lens Assisted Pharmacological Induced
Kerato-Steepening (CLAPIKS). He wanted to be able to correct
previous laser refractive surgical patients who developed hyperopia,
had residual hyperopia or didn't have enough myopia at near for
monovision. Dr. McDonald credits Tal Raviv, MD, for giving him the
idea because Dr. Raviv presented a paper at the 1999 American
Society of Cataract and Refractive Surgery meeting describing
topical ketorolac treatment of hyperopia in overcorrected myopic
CLAPIKS treatment consists of a patient wearing a steep-fitting
contact lens continuously while instilling NSAID drops q.i.d. for
two weeks in the affected eye. After two weeks the practitioner
removes the lens and performs a new manifest refraction to measure
the results of the treatment. Practitioners should inform patients
that this is an off-label use of the NSAID and of the lenses.
the CLAPIKS treatment on eight patients (10 eyes) who had previously
undergone laser refractive surgery. Seven patients had hyperopic
overcorrection and one needed an increase in myopia. The required
hyperopic correction ranged from +0.50D to +1.50D. The required
myopic increase was -0.50D.
continued for two to three weeks. All patients used either Acular PF
or Acular LS (both Allergan) except for one who used Voltaren
(Novartis Ophthalmics). All patients wore the Night &Day lens (CIBA
Vision) with the exception of one who used an O2Optix
lens (CIBA). One patient underwent CLAPIKS two weeks after LASEK
surgery. Some had the procedure within one year of surgery and
others underwent CLAPIKS years after their laser treatment (Table
TABLE 1 Progression of Patients Who Underwent CLAPIKS
treated Patient ML in both eyes two weeks after her LASEK surgery
because of a +1.25D spherical hyperopic overcorrection OU. Her best
visual acuity with correction was 20/40 in each eye. After two weeks
of CLAPIKS, her manifest refraction was plano with a best visual
acuity of 20/30 in each eye. Four months later she had a correction
of +0.50D OU and a best visual acuity of 20/20 in each eye. Two
questions arise: Did she really need the CLAPIKS treatment and how
long does the CLAPIKS last?
experiencing subjective complaints at near, so the treatment may
have alleviated her symptoms sooner than if she hadn't undergone the
treatment. Because she became more hyperopic later, is this
treatment really effective?
DB and JB had their laser surgeries in 2000 and 2001, respectively.
DB complained of blurred vision in the right eye. The manifest
refraction OD was +1.50D sphere with 20/20 VA. After CLAPIKS for two
weeks, the manifest refraction OD was plano with 20/20 VA.
manifest refraction was OD -0.50 +2.50 x065 20/30, OS +0.50 sphere
20/25. After CLAPIKS for two weeks, the manifest refraction improved
to OD plano +1.00 x60 20/30 and OS plano 20/20. We requested that he
return in two to three months to check stability of the treatment.
patient (CE) used Voltaren instead of Acular. Her manifest
refraction was OS +0.75 sphere 20/25. Two weeks later after CLAPIKS
treatment, the manifest refraction was variable from +0.25 to +0.75,
but her VA was 20/20 and subjectively she felt that her vision was
better. The question here is, does Voltaren not work as well as
Acular or is this patient's eye resistant to CLAPIKS?
Discussion and Conclusions
mechanism of how CLAPIKS works isn't clear. Dr. McDonald et al
postulate that the CLAPIKS treatment molds and structures the
corneal curvature to a steeper conformation by the NSAID affect on
the epithelial cell arrangement and anterior stromal proteoglycan
swelling. The contact lens serves as a mold and assists this
from Dr. McDonald's protocol by using high-Dk/L lenses for all
patients and once using Voltaren instead of Acular. Clinically,
besides refraction and subjective improvement noted by the patients,
you could assess corneal curvature and topography pre- and post-CLAPIKS
treatment to see if corneal curvature changes can be documented.
CLAPIKS work for hyperopic patients who have not undergone laser
refractive surgery? Dr. McDonald doesn't think so. Clearly, further
study is needed.
submitting this article I've attempted the CLAPIKS treatment on a
natural hyperope (has not had any refractive surgery) and on a
hyperopic patient who underwent LASIK, but the refraction regressed.
There was no affect on the manifest refraction after two weeks of
present, clinically I can conclude that CLAPIKS seems to work well
for myopic LASIK patients who present with some overcorrection.
CLAPIKS worked in the one myopic LASEK patient I treated, but I'd
need to treat more such patients before I could come to a
think CLAPIKS will be successful for naturally hyperopic patients or
for LASIK patients who were hyperopic before undergoing surgery.