Article

CLINICAL: CONTACT LENSES

MAKE THE EFFORT IN SCLERALS

SCLERAL LENSES PROVIDE THE BEST VISUAL OUTCOME FOR SOME PATIENTS

MANY LECTURES and journal articles discuss the advantages of fitting scleral contact lenses. But in practices that may not have huge patient volumes for this technology, eye care professionals may ask themselves, “Why make the effort?”

The simple answer: Scleral lenses have the potential to improve patients’ visual outcomes and their quality of life. If a patient has an irregular cornea, his or her visual needs are not being met with traditional spectacles or contact lenses. In addition, the evidence is overwhelming that scleral lenses can “improve visual acuity in patients whose surface disease has compromised vision,” according to Ophthalmology. And, scleral lens fittings are growing among O.D.s. A recent SCOPE (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) study found that a majority of lens fitters, more than 75%, fit their first scleral lenses after 2006, according to a poster presented at 2016 Global Specialty Lens Symposium.

Pachymetry demonstrates thin zones within the cornea, information useful in fitting sclerals.
Courtesy of Jason Miller, O.D.

Consider taking these steps to evaluate patient needs for scleral lenses in your practice.

1 IDENTIFY PATIENTS

Make the effort to utilize scleral lenses for a variety of situations. Although scleral lens options exist for those who have both normal and irregular corneas, those who may benefit significantly are patients with a variety of corneal irregularities and corneal diseases, including keratoconus. There is a good chance these patients either had an unsuccessful contact lens fit in the past or were told contact lens wear was not possible.

2 GATHER DATA

Now, gather data to create a solid view of the case from outside to inside the corneal structure. Specifically, topography will allow you to identify where the corneal irregularities are. Additionally, pachymetry measurements will demonstrate thin zones and provide a microscopic map of corneal thickness. Anterior segment photography may help demonstrate central corneal clearance value and, later, allow you to see the lens fit on the eye. Finally, anterior segment OCT (AS-OCT) may provide an even more detailed view of the corneal surface structures and scleral lens fit.

3 UNDERSTAND THE FITTING SET

Finally, use the data to identify the scleral lens that will best meet your patient’s needs. The data can also help you when paired with the manufacturer’s fitting set and guidelines to make adjustments in the fit and, ultimately, maximize success. Fitting sets allow the clinician to optimize the central corneal clearance, the limbal clearance and the scleral landing zone.

CONSIDER SCLERAL LENS TECHNOLOGY

It is important to understand how to utilize technology in your specific practice situation. Scleral lenses have the potential to improve patients’ visual outcomes and their quality of life. Make the effort. OM