Refractive change during hyperbaric oxygen therapy. A clinical trial including ultrasound oculometry

To record changes in refraction and refractive parameters associated with a standard hyperbaric oxygen treatment protocol consisting of a 95 min session at > 95% oxygen at 2.5 atmospheres (ATA) given daily Monday to Friday, to a total of 30 sessions.

Seventeen of the 26 patients included were able to attend for ophthalmic assessment at time zero (to) and after 20 treatments (t20). Thirteen patients also had a post-treatment follow-up. Most patients were being treated for osteoradionecrosis after radiotherapy of ENT cancers, and drop-outs for the eye exam were common. Refraction was determined subjectively and by refractometry, before and after tropicamide 1% eyedrops. Refractive parameters were assessed by keratometry and by A-scan axial ultrasound measurement.

Results are given for the 17 patients with to and t20 assessments. The induced refractive change ranged from 0 to 1.5 D. When observed, refractive changes were myopic in nature. The shift averaged 0.58 D according to the refractometer and 0.49 D as subjectively assessed, with corresponding median change values being 0.62 and 0.39 D. The differences between 0 D and these values, although small, were statistically highly significant.

The refractive changes associated with hyperbaric oxygen therapy were smaller than the literature had led us to expect. No significant change in axial eye length measurements was found, and keratometry readings reflected only minimal change, although this was statistically significant on a 0.05 level. Therefore it is most likely that lens changes, whether in internal refractive indices or curvatures, accounted for the transitory shift towards more myopic/less hyperopic values.