Check out my article in GP Insights on scleral lens fenestrations.

 

 


The Scleral Lens Education Society, in partnership with B+L, has put together a comprehensive video on the application/removal and care of scleral lenses.

Application/Removal and Care of Scleral Lenses Video


Improvements in specialty lens designs have made this contact lens modality a viable option for patients who have mild to moderate keratoconus. Generally, these soft lenses have center thickness 4X  greater than standard soft lenses, which allows them to mask surface irregularity caused by keratoconus. When necessary, they can be manufactured using silicone hydrogel material that increase oxygen to the corneal surface. Specialty soft lenses for keratoconus can be a successful alternative when standard GP designs fail secondary to comfort issues.

For mor information, read my article on this subject that I co-authored with Dr. Eiden in Contact Lens Spectrum.

http://www.clspectrum.com/articleviewer.aspx?articleID=106552


The 2012 Global Specialty Lens Symposium was held in Las Vegas from January 26-29th. Over 450 contact lens practitioners from all over the world participated in this year’s meeting, and scleral lenses were a popular topic.  I was honored to have been selected to present two lectures, one of which included information about managing post-operative corneal irregularity with scleral lenses.


 

Scleral Lenses can range in diameter from 12.5mm to 25mm.  I generally use scleral lenses that are 18mm for most cases of corneal irregularity or ocular surface disease.


Check out my article in Contact Lens Spectrum.

Surgical Comanagement and Contact Lens Fitting


Scleral lenses can be used for cosmetic restoration in cases of severe anterior segment scarring.  Prosthetic scleral lenses are not permeable to oxygen and so the eye has to be monitored for hypoxic related complications.


Check out my article in Optometric Management.

Scleral Lens Fits Simplified


Scleral lenses hold a liquid reservoir and ideally should be without air bubbles when properly fit and applied.  If excessive saline is spilled from the lens during application or the lens is first positioned off center, then air bubbles may be present.  Small to medium bubbles will not affect vision, fit or comfort.  However, if the lens does not feel comfortable and/or the vision is disrupted, then the lens will have to be reapplied.  The photograph shows an air bubble secondary to application error that is not affecting vision or comfort.


Eef van der Worp and colleagues at Pacific University have done some novel research studying the shape of the sclera.  For scleral lens patients this is important because scleral contact lenses needs to conform and fit to the sclera.  Dr. van der Worp has concluded that on average the sclera is nonrotationally symmetric.  In other words, the sclera is not symmetrically round or toric.  This important research will undoubtedly affect future lens design and manufacturing, with a push towards quadrant specific back surface haptics.