Anterior segment optical coherence tomography angiography to evaluate the peripheral fitting of scleral contact lenses

Abstract

PurposeThe aim of this study was to show the potential applicability of optical coherence tomography angiography (OCTA) for the evaluation of the peripheral fitting of fully scleral contact lenses.MethodsA pilot study was proposed fitting three different scleral contact lenses (Irregular Corneal Design [ICD]) with different sagittal heights (4200, 4800, and 5600 mm) in a healthy volunteer of 27 years old. We evaluated by means of optical coherence tomography (OCT, DRI Triton) the apical clearance achieved with each of the three lenses fitted. The impact over scleral flow was assessed with the OCTA module of the same device.ResultsThe apical clearance was 310, 901, and 1680 µm with the scleral lenses of sagittal heights 4200, 4800, and 5600 µm, respectively. With OCTA, we evaluated the impact of the lens bearing on the conjunctival vascular flow, observing an area of vascular interruption of 0, 25, and 75% with the lenses of 4200, 4800, and 5600 µm of sagittal heights, respectively. The vascular interruption was induced in the perilimbar area, suggesting the need of readjusting the limbal clearance zone of the lens.ConclusionFully scleral contact lens fitting may be optimized with the use of OCTA, allowing the practitioner to perform the fitting with better control of the peripheral bearing of the lens on the conjunctival tissue, assessing the impact on vascular structures. This potential use of OCTA must be investigated further in future studies including large samples of eyes.

Efficiency and Safety of Scleral Lenses in Rehabilitation of Refractive Errors and High Order Aberrations After Penetrating Keratoplasty

“…To reduce ocular complications and discomfort anterior segment OCT imaging could be beneficial. 25 In addition, patient education is extremely important to prevent unwanted complications, even in patients with PK.…”

Characterization and prediction of the clinical result with a specific model of mini-scleral contact lens in corneas with keratoconus

“…For a customized optimal adjustment, the lens has 4 differentiated zones that can be modified: central clearance zone (CCZ), peripheral corneal clearance zone (PCCZ), limbal clearance zone (LCZ) and scleral landing zone (SLZ) [ 16 ]. This SCL has been designed to be fitted mainly in irregular corneas [ 6 , 16 , 22 – 25 ]. The fitting was performed following the manufacturer guidelines: selection of the initial diagnostic lens according to the fitting table, insertion of the CL, evaluation of CCZ, assessment of central clearance, slit lamp examination of the SCL after 60 min of wearing and finally measurement of the over-refraction (ORx) to determine the final power of the CL [ 16 ].…”

How Can We Best Measure the Performance of Scleral Lenses? Current Insights

“…Short-term changes in the bulbar conjunctiva and scleral tissue following SL wear have been identified with scleral topographers. 35 , 75 , 76 , 119 Gimenez-Sanchis et al 54 evaluated the peripheral SL fitting with AS-OCT angiography, which imaged limbal and conjunctival blood flow, and concluded that SL fitting could be optimized with the use of this technology.…”