Expand the use of sclerals to provide your patients with additional possibilities.
Most practitioners are aware of the usefulness of scleral lenses in restoring vision in the irregular cornea. This benefit can be seen in primary corneal ectasia, such as keratoconus and pellucid marginal degeneration, and in secondary corneal ectasia, such as unsuccessful LASIK or corneal trauma.
|Blanchard’s Onefit Scleral is supported by the
conjunctiva and the fluid layer under the lens,
rather than by the cornea.
Perhaps surprisingly, scleral lenses are indicated in a wider variety of ocular conditions as well. Since scleral lenses retain a fluid reservoir between the lens and the cornea, they can help manage ocular surface disease such as SjÃ¶gren’s syndrome. And, sclerals don’t have to be limited to the difficult cases. Since they rest on the less sensitive conjunctiva, sclerals often have improved comfort over traditional gas permeable (GP) lenses, even in the patient with normal refractive errors as described below.
A 55-year-old male, high myope was monocular after a retinal detachment in his right eye. Spectacle prescription in his left eye was -12.00 -1.75 x 180, correctable to 20/30. He complained of fluctuating vision and lens awareness with his GP lens. I decided to fit the patient with a mini scleral lens. Often vision is sharper with smaller amounts of clearance so this can be an option for a patient who does not need a lens with a deep sagittal depth. After reviewing his corneal topography, I ordered a Onefit Scleral lens from Blanchard Contact Lens, Inc. in the following parameters:
OS: 7.60 BC, 14.30 diameter, standard edge
After the lens arrived, we filled the bowl with preservative-free saline and let it settle on the patient’s eye for 30 minutes. Corneal apical clearance was then assessed. Ideally, this lens should have around 200 microns of clearance. Since a smaller amount was observed, I knew that the lens should be ordered steeper, especially since scleral lenses settle more throughout the day. It’s also necessary to assess the clearance over the limbal area. Due to the presence of stems cells in this area, it’s important to avoid mechanical pressure. The patient had an adequate amount of limbal clearance. I then assessed the peripheral fit. Since I noted peripheral seal off, in the form conjunctiva vessel blanching, a new lens was ordered with a flat edge lift. Lastly, an over-refraction was performed to finalize the prescription. The new lens was ordered in the following parameters:
OS: 7.00 BC, 14.30 diameter, edge lift Flat I
The new scleral lens looked great at dispensing so a follow-up visit was scheduled several weeks later. At that time, the patient reported the lens was much more comfortable and the vision was more stable than his previous GP lens. Cornea and conjunctiva were assessed for staining and none was noted. The patient’s acuity was 20/25 in his left eye. He was very satisfied with the result.
Scleral lenses have a wide variety of applications. They have superior comfort and stability to the traditional GP lens so they need not be the lens of last resort. Scleral lenses may seem daunting, but with a fitting plan and some practice, they can help achieve satisfactory vision and comfort in your harder-to-fit contact lens patients.
Jenny Kiernan specializes in fitting contacts lenses at Eye Consultants of Colorado in Conifer, CO.
WHERE TO FIND IT:
Blanchard Contact Lens, Inc. •800-367-4009 •blanchardlab.com