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Purpose: To evaluate the indications and efficacy of high gas permeable scleral contact lenses (GP-SCL).
Methods: A total database of 97 consecutive patients (140 eyes) fitted with GP-SCL between January 2003 and December 2008, was retrospectively analyzed to determine the benefits of fitting scleral lenses. All lenses were fitted by preformed tech...
Context in source publication
Context 1
... an average lens, the internal optic zone of 12.5 mm was a single curve surrounded by a 1.5-2.0 mm wide transitional zone vaulting the limbus and merging seamlessly into the posterior haptic surface (Figure 1). The haptic parameters of individual lenses were determined by observing the vascular compression patterns of the bulbar conjunctiva, using a series of diagnostic lenses of different haptic designs aimed at minimizing lens induced compression of conjunctival blood vessels and enabling unobstructed blood circulation. ...
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Citations
... Although lamellar or full-thickness keratoplasty improves visual acuity in eyes with corneal scarring, it must be noted that scleral lenses may still be necessary to reach the bestcorrected post-surgical visual acuity. [10][11][12][13] ...
Scleral contact lenses (ScCL) provide a good therapeutic option in patients of moderate to advanced keratoconus where vision cannot be improved with rigid corneal contact lenses, either because of poor lens centration or inability to fit such a lens. One advantage of these lenses is that they are supported by the sclera and therefore can be fitted on eyes with markedly irregular corneas. Secondly, there is a constant aqueous reservoir between the lens and the cornea which neutralizes most of the irregular astigmatism and plays protective role too. These lenses may also delay the need for keratoplasty in patients who have exhausted other options for visual correction.
... [4] It provides an effective option for the correction of residual ametropia and high-order aberrations and masking surface corneal irregularities with the tear lens between the posterior lens surface and the anterior corneal surface. [5] There are only few studies which have studied the visual outcome with scleral lenses in irregular corneas. In this prospective pre-post, observational study design, we evaluated the visual outcome of the patients fitted with SCLs. ...
Purpose:
The purpose is to study the change in visual acuity obtained with sclerocorneal contact lens (SCL) in patients with irregular corneal astigmatism.
Methods:
A prospective pre-post observational study was designed to include consecutive consenting patients with irregular corneal astigmatism and best-corrected visual acuity worse than 6/12 and fitted with SCL. Visual acuity was assessed using Snellen charts before fitting SCL and 1 week after the fit and converted to the equivalent logMAR units for analysis.
Results:
We included 51 eyes of 41 patients with a mean age of 26.31 ± 8.86 of which 32 (78%) were men. Keratoconus was the most common indication (n = 42 eyes, 82.35%), followed by corneal scar (n = 3, 4%), post keratoplasty (n = 2, 4%), high myopia (n = 2, 4%), pellucid marginal degeneration (n = 1, 2%), and aphakia (n = 1, 2%). The mean overall uncorrected visual acuity improved significantly (P < 0.001) with SCL from 1.18 ± 0.34 logMAR (6/120 Snellen's equivalent) to 0.27 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting. The mean overall best spectacle-corrected visual acuity improved from 0.89 ± 0.45 logMAR (6/36 Snellen's equivalent) to 0.26 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting.
Conclusion:
Sclerocorneal contact lens improves visual acuity significantly in patients with irregular corneal astigmatism and reduces the need for corneal transplantation.
... As SCL is a large-diameter gas-permeable device specially designed to rest on the sclera and vault over the entire corneal surface, not bearing on the corneal structure and consequently respecting it, it is an ideal option for visual rehabilitation in KC [9]. Indeed, KC is the main indication of the use of these lenses [7,8,[10][11][12]. Koppen et al. [13] reported that SCLs mitigated the need for corneal transplant in 80% of patients with severe KC. ...
Background:
To investigate which factors are correlated with the visual improvement achieved with a specific model of scleral contact lens (SCL) in keratoconus (KC) eyes and to define a model to predict such improvement according to the pre-fitting data. In addition, the changes occurred with the fitting of a specific model of SCL during a period of 3 months in corneas with KC have been investigated.
Methods:
Longitudinal retrospective study including 30 eyes of 18 patients (age, 14-65 years) with KC fitted with the SCL ICD16.50 (Paragon Vision Sciences). Visual, refractive, corneal tomographic and ocular aberrometric changes were evaluated during a 3-month follow-up. Likewise, the characterization of the post-lens meniscus was performed by optical coherence tomography (OCT) with the measurement of central, nasal and temporal vaults.
Results:
The visual acuity increased significantly from a mean pre-fitting value with spectacles of 0.23 ± 0.07 logarithm of minimal angle of resolution (logMAR) to a mean value of 0.10 ± 0.04 logMAR after 1 month of SCL wear (P < 0.001). An improvement of 1 or more lines of visual acuity with the SCL occurred in 62.1% of the eyes. A significant decrease in central, nasal, and temporal vault was observed after 1 month of SCL wear (P ≤ 0.046). Likewise, there was a significant difference between nasal and temporal vaults during the first month of SCL use (P = 0.008). Furthermore, a significant reduction of ocular high order (P = 0.028) and primary coma root mean square (P = 0.018) was found with the SCL. A predicting linear equation of the change in visual acuity achievable with the SCL was obtained (P < 0.001, R2 = 0.878) considering the pre-fitting spectacle corrected distance visual acuity, and the power and sagittal lens of SCL.
Conclusions:
The scleral contact lens evaluated provides an efficacious visual rehabilitation in KC due to the improvement of visual acuity and the correction of low and high-order ocular aberrations. This visual acuity improvement can be predicted from some pre-fitting variables.
... 2 Donald F. Ezekiel, AM, Dip Opt WA, DCLP, reintroduced the concept using modern manufacturing methods, including the use of higher oxygen permeability materials. 3,4 Over the last 10 years, technological advances in materials and designs, and a better understanding of the ocular surface, have made scleral lens designs more refi ned and indispensable. ...
32 NAVIGATING LENS CHOICE I t Õs diffi cult not to observe that the recent industry focus on scleral contact lenses-whether pertaining to clinical education, research and development, and/ or practice management-has defi nitely outpaced the attention paid to corneal gas permeable lenses. While we enthusiastically embrace the continuing developments in scleral lens technology, it's critical that we likewise devote educational curricula, professional resources, and industry support to ensure that corneal GP lenses remain an equally viable and valuable tool in our management of patients requiring rigid lens designs. 1 Contact lens fi tting in general involves a high level of clinical decision making and, perhaps even more when it pertains to complex refractive errors, underlying pathology, and/or irregular corneal or scleral shape. While we were invited to present a point-counterpoint, we fi nd it difficult to choose between two lens modalities , as we are deeply convinced that each one has its place in current contact lens practice. Here, we present key considerations and a clinical rationale for deciding between scleral lenses and corneal GP designs. HISTORICAL PERSPECTIVE Scleral lenses were the fi rst vision-correcting lenses in the 19th century, but for a long time they were limited by technology. They could not be manufactured in a relatively reproducible way, and their design could not be too complex, as they were made with blown-glass techniques or by hand with tools that were much less precise than the machines we have today. The primary challenge in their use was the physiological response to wearing them. With low oxygen permeability and thick lens designs, scleral lenses were often associated with signifi cant levels of hypoxia that were detrimental to the patient's condition. 2 Donald F. Ezekiel, AM, Dip Opt WA, DCLP, reintroduced the concept using modern manufacturing methods , including the use of higher oxygen permeability materials. 3,4 Over the last 10 years, technological advances in materials and designs, and a better understanding of the ocular surface, have made scleral lens designs more refi ned and indispensable. The fi rst all-plastic polymethylmethacrylate (PMMA) corneal lenses were developed in the late 1940s. They were smaller than the originally designed scleral contact lenses of the 1930s and early 1940s, which were made of glass or a glass/plastic combination. While these new smaller lenses greatly improved comfort and wearing time due to their thinner and lighter profi le, there Intel on navigating the choice between these lens modalities.
... • Lens insertion requires a relative motor skill, with adequate head position and precise hand movements to prevent leakage of the fluid chamber or air bubbles trapped under the lens. Hypoxia is a major concern mainly in some situations such as in post-keratoplasty fitting; may occur in some cases, mainly in lenses made of low-Dk materials, which are rare nowadays; and may be linked to excessive vaulting and/or high-thickness lenses (6)(7)(8)(9)(10)(11)(12)(13)(14) . Thus, scleral lenses are optical and therapeutic devices that may be an excellent option when soft or rigid gas-permeable (RGP) corneal lenses cannot be successfully fit. ...
... As regard to the therapeutic indications of scleral lens, the main conditions are scarring diseases of the cornea and conjunctiva (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, cicatricial entropion, and post herpetic keratitis) and cases of severe dry eye (exposure keratopathy, congenital deficiency of the meibomian glands, superior limbic keratoconjunctivitis, and Sjögren syndrome) (8)(9)(10)(11)(12)(13)(14)(15)(16) . This kind of use is related to lacrimal retention between the cornea and lens and ocular protection in cases of exposure keratitis and eyelid or eyelash abnormalities. ...
Purpose:
The aim of this study was to evaluate the fitting process of a scleral lens that allows several parameter adjustments during trials and after the initial period of use. In addition, we verified which adjustments were needed and used the most, their indications, and how often these resources were used, and checked the results.
Methods:
Scleral contact lens fittings in a private clinic setting were prospectively analyzed in a sequential, non-randomized, and non-comparative manner. All the patients underwent a complete ophthalmic examination and had an indication for scleral lens use (Zenlens, Alden Optical).
Results:
Scleral fit was analyzed in 80 eyes of 45 patients. Regarding diagnosis, 72% of the patients had keratoconus; 12%, radial keratotomy; 5%, post-refractive surgery ectasia; 5%, dry eye; and 3%, high myopia. In 66 (82.5%) of the 80 eyes studied, parameters were modified when the lenses were ordered. The reasons that led to the modifications were apical touch or decreased sagittal height, increased sagittal height, cylindrical over-refraction, poor visual acuity, lens flexure, peripheral touch, 360° edge compression, horizontal edge compression, and vertical edge compression.
Conclusion:
In this study, the use of Zenlens scleral lenses was shown to be a promising corrective treatment for patients requiring the use of scleral lenses. Although the study suggests a learning curve, as many adjustments were allowed, the lens could be customized according to the patients' needs. This increased the success rates of fitting and wearing, and consequently, use of the lens became a great option for the visual rehabilitation of patients.
... Prescription and management practices for scleral lenses have been studied through both single-center retrospective reviews [1][2][3][4][5][6] and survey research [7,8]. Although useful, both approaches have limitations for understanding how scleral lenses are being prescribed. ...
Purpose
To describe international scleral lens prescription and management practices across multiple practice types.
Methods
For this cross-sectional study, scleral lens practitioners were asked to complete an electronic survey that requested information about a single scleral lens patient. Data collected included practitioner demographics (practice type, country, years of experience) and patient indications for scleral lens wear, fitting process, lens design, and care products.
Results
Data were collected for 259 patients (419 eyes). Most participants (60%) practiced in the US, 75% worked primarily in community practice, and 58% claimed more than 5 years’ experience fitting scleral lenses. Indications for scleral lens wear were corneal irregularity (87%), ocular surface disease (9%), and uncomplicated refractive error (4%). During the fitting process, the mean (SD) number of lenses ordered was 2.4 (1.6) (range, 1–16 lenses) during 3.8 (2.4) visits (range, 1–18 visits). Of patients, 62% used a daily surfactant cleaner, 47% used hydrogen peroxide disinfection, and 67% used single-use vials of nonpreserved saline. Mean lens diameter was 16.2 (1.1) mm (range, 11.8–23.0 mm). The landing zones were spherical (64%), toric (26%), quadrant-specific (7%), and custom (3%) designs. Optical power was spherical in 70%, toric in 27%, and higher-order aberration correcting in 3% of lenses. Only 5 lenses had multifocal optics.
Conclusions
General consensus regarding prescribing patterns (lens design, wearing schedules, care products) between US vs non-US, community vs academic, and new vs established providers is reported in this study. Relatively low percentages of patients wearing lenses with advanced landing zones or optical designs suggest that these new options have not been widely adopted.
... The development of scleral lenses with a smoother continuous back surface, precisely following the underlying ocular structures has made prolonged, comfortable scleral lens wear possible. Moreover, the combination of high oxygen permeability SL materials and sophisticated lens haptic geometry may diminish the incidence of complications such as corneal edema or lens adhesion [24]. ...
Purpose
To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients.
Methods
The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported.
Results
Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diopters (D). In six eyes with advanced KCN (Kmax 71.8 ± 11.0 D) and three eyes with traumatic scarring, SL use obviated the need for keratoplasty. Fifteen patients (83 %) continued scleral lens wear with a mean follow-up period of 9.2 ± 7.4 months. Complications included one case of corneal graft rejection and one corneal abrasion associated with lens insertion.
Conclusions
The goals of SL fitting in pediatric patients are visual rehabilitation and ocular surface protection. Pediatric patients with advanced keratoconus and traumatic corneal scarring are most appreciative of the benefits of scleral lenses. The challenges associated with SL fitting and the training process did not preclude long-term SL wear.
... Most of the studies reporting on the therapeutic use of contact lenses for the treatment and management of ocular cGVHD focus on the use of scleral lenses [14,76,221,222,[227][228][229][230][231][232][233][234]. Although the therapeutic benefits of scleral lenses were reported as early as the 1970s, a large retrospective case series in 2005 [14,67] analysed 875 eyes of 538 patients fitted with fluid-ventilated, gas-permeable scleral lenses (PROSE, BostonSight, Needham, MA) during an 18-year period [14]. ...
... An improvement in vision and clinical signs was reported by others with other scleral lenses soon after, including paediatric patients with ocular cGVHD [228,234,236]. Table 2 summarises the literature on the effect of scleral lens treatment and management on QOL, visual function, and dry eye symptoms in patients with ocular cGVHD. ...
... Several large retrospective reviews indicate that many patients fitted with daily wear scleral lenses for long term use are able to successfully wear these for 12-16 h (range 3-19 h) [74,228,486,488,797,802]. A large retrospective study found an average of 10 h or more wearing time in 59 % (n = 538) of patients [488]. ...
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
... Scleral lenses have increased in popularity in the last decade. According to the Scleral Lens in Current Optometric Practice study, 80% of the 989 respondents indicated their first year of fitting to be after 2005, and 54% began 2010 or later. 1 It was estimated that in 2016, 70,000 individuals in the United States wore a scleral lens. 2 Modern scleral lens indications include corneal ectasia (27.5 to 91%), 3-10 post-surgical or post-traumatic corneal irregularity (17.6 to 40.0%), 3-6,8-10 ocular surface diseases (3 to 49%), [3][4][5][7][8][9][10][11] aphakia (2 to 23%), 3,7-9 refractive errors (2.6 to 10%), 3,8,10,11 and others. 1,12 Keratoconus is the primary indication for scleral lens wear. ...
... Although lamellar or full-thickness keratoplasty improves visual acuity in eyes with corneal scarring, it must be noted that scleral lenses may still be necessary to reach the best-corrected post-surgical visual acuity. [7][8][9]22 Little is known about the rates of adverse events in contemporary scleral contact lenses, and many of the adverse events previously reported are from PMMA or first-generation gas-permeable designs. 3 Other more contemporary studies have focused on case reports and case series or are limited by small sample sizes in a single lens type. ...
... Consistent with the findings of other groups, our study demonstrates excellent long-term safety and efficacy of scleral lenses in the visual rehabilitation in subjects with keratoconus. 7,9,26,28,31,32 ...
Significance:
This study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus.
Purpose:
This study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population.
Methods:
A retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for ≥1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma.
Results:
A total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 ± 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 ± 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens-induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses (P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression.
Conclusions:
Consistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.
... In addition to the short term nature of these studies, the majority have been conducted on patients with normal corneas, which is not the primary indication for scleral lens wear. Other studies have reported success rates of scleral lens wear that range from 62 % to 89 % [14][15][16][17][18][19][20][21]. However, all of these retrospective analyses differ with regard to scleral lens indications, sample size, scleral lens design, mean follow-up time, study design, and definition of success. ...
... Similarly, in 1997 Pullum and Buckley [16] reported a discontinuation rate of 22 %. More recently, other retrospective studies showed similar failure rates: Severinsky et al. [17] presented a failure rate of 21 %, Schornack et al. [18] reported that 38 % of their keratoconus patients chose not to proceed with the fitting process after the initial evaluation, and Segal et al. [19] mentioned a failure rate of 10.4 % in their study. ...
... Several reasons to discontinue scleral lens wear have been proposed, ranging from a lack of visual benefit [15,18,20,21], handling issues [18,19,21] and discomfort [20,21], to adverse events related to ocular complications (intolerance, graft rejection, neovascularization, corneal epithelial defects, hyperemia and corneal edema) [15,22,32] or abandoning scleral lens wear to undergo surgery (penetrating keratoplasty, cataract surgery) [17,18]. In the present study, the main reasons for scleral lens discontinuation were handling issues (35 % of the participants: 31 % in the IC Group and 40 % in the RC Group) and discomfort (19 % of the participants: 25 % in the IC Group and 10 % in the RC Group). ...
Purpose:
To report the success rate of scleral lens wear and the lens handling learning curve from the wearers perspective.
Methods:
Ninety-five participants were consecutively screened for enrollment in a prospective study. Participants were divided into two groups: ICGroup (71 participants with irregular corneas) and RCGroup (24 participants with regular corneas). Participants attended several visits: Baseline, Lens Dispense Visit (LDV), 1-month, 3-month, 6-month and 12-month follow-ups. The number and causes of scleral lens discontinuation and the time to correctly apply the lens for the first time at the LDV were evaluated. During follow-ups, participants answered a questionnaire regarding scleral lens wear (mean number of hours/day and days/week of lens wear, methods used for handling, number of attempts to correctly apply and remove the lenses).
Results:
Sixty-nine participants (73 %) successfully completed the 12-month period. Twenty-six participants (27 %) discontinued scleral lens wear. None of the discontinuations were due to adverse events. The success rate (number of participants that wore the lenses for the 12 months) was 77 % in ICGroup and 58 % in RCGroup. The main reasons for scleral lens discontinuation were handling issues (35 %) and discomfort (19 %). 36 % of participants required <15 min to correctly apply the lens at the LDV, however 13 % required >60 min (participants that wore spectacles, soft lenses or had no correction method at Baseline). The mean wearing time (hours/day and days/week) increased significantly from 1-month to 12-month appointments: from 9.8-11.1 h and 5.1-5.6 days in new scleral lens wearers, while the number of attempts to correctly apply and remove the lenses decreased significantly.
Conclusions:
The success rate was 73 % during this prospective 12-month follow-up study. The main reasons for drop-out were handling issues and discomfort. Participants who continued scleral lens demonstrated increased handling skills.
