First Experience With the ICD 16.5 Mini-Scleral Lens for Optic and Therapeutic Purposes

Suarez, Cyrielle; Madariaga, Virginie; Lepage, Benoît; Malecaze, Marie; Fournié, Pierre; Soler, V.; Galiacy, Stéphane; Mely, R. G.; Cassagne, Myriam; Malecaze, François

doi:10.1097/icl.0000000000000293

Cited by 21 publications

(24 citation statements)

References 25 publications

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“…In this short communication, we report the fitting of a scleral contact lens with two peripheral areas, such as LCZ and SLZ, allowing theoretically a better control of the limbal clearance and how the lens rests on the conjunctival surface. 3 , 4 However, to date, the planning of changes in these areas are only based on subjective biomicroscopic analysis or on OCT images, but without knowing the real impact on the inner structures and vasculature of the superficial signs observed on slit lamp or OCT examination. OCTA is an additional option to control the impact of the peripheral scleral lens bearing on conjunctival vasculature and therefore to avoid complications derived from an excessive compression of the conjunctival tissue.…”

Section: Discussionmentioning

confidence: 99%

“…There has been an increasing interest in fully scleral gas permeable (GP) contact lenses in the last years 1 , 2 due to their ability of providing a successful visual rehabilitation in complex cases, such as irregular cornea (primary or secondary) and several dry eye cases, with a very comfortable wear, 3 – 5 even in those cases where all other contact lens options fail. 6 Although the fitting of these contact lenses has been simplified significantly in the last years, there are still some challenges in this process, 7 including the control of the relationship between lens and conjunctival surface and the level of lens indentation.…”

Section: Introductionmentioning

confidence: 99%

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

Gimenez-Sanchis¹,

Palacios-Carmen²,

García-Garrigós³

et al. 2018

OPTO

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gimenez-Sanchis¹,

Palacios-Carmen²,

García-Garrigós³

et al. 2018

OPTO

View full text Add to dashboard Cite

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“…4 Other studies showed a much lower rate of abandoning ScCL due to handling problems. [5][6][7][8][9][10] One study broke down handling difficulty establishing that with application, 20% of patients had mild difficulty while 12% had moderate difficulty; and with removal, only 9% of patients had mild difficulty. 11 Kornberg and Wang found that application and removal was not a laborious process.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Whereas, other studies have debunked difficulties with ScCL handling. 1,[5][6][7][8][9][10][11][12] ScCL complications related to handling are rare and most are managed without any lasting side-effects. It is crucial that patients understand the application and removal process and are trained in handling ScCL as patients may have initial difficulty with this process.…”

mentioning

confidence: 99%

Scleral Lens Issues and Complications Related to Handling, Care and Compliance

Fadel

Toabe

2018

JCLRS

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Scleral contact lens (ScCL) handling may be challenging and is the principle reason for ScCL drop out. ScCL care systems are more intricate than other lens modalities and include solutions for cleaning, disinfection, storing, rinsing and filling the lens; respecting the use of each solution recommended is fundamental. Replacement of the lenses, solutions, case and plungers are important in order to decrease the risk of adverse events associated with ScCL wear. Compliance is crucial regarding hygiene, solution use, case and plunger care, wear time, follow-up schedule, and handling techniques. Non-compliance may lead to discontinuation of ScCL due to difficulties associated with this unique lens design. This paper presents complications secondary to handling, care and compliance that clinicians and patients may encounter while wearing ScCL. Instructions are provided to enhance the understanding on management surrounding these issues. This manuscript includes three tables to summarize types of complications, their symptoms, clinical signs, etiology, and management for a quick find index for easy consultation during daily clinical practice.

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“…The ICD lens from Paragon was used, which has been shown in previous studies and series to be a good option for irregular corneas. 9,10 We began the fitting with the spherical model of the lens, using a sagittal height calculated according to OCT measurements. The trial lens selected provided a comfortable wear and initially a good level of visual acuity, but the visual acuity worsened significantly at 15 days of wear.…”

Section: Discussionmentioning

confidence: 99%

Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus

Soto-Negro¹

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

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We report the case of a 35-year-old woman diagnosed with keratoconus since she was 18 years old and wearer of corneal rigid contact lenses (CLs). We refitted the case with the fully scleral CL ICD16.5 (Paragon Vision Sciences) for obtaining not only a successful visual restoration, but also a comfortable wear. We initiated the fitting with the spherical model of the CL, but it failed due to instability of the lens. We confirmed the presence of a clear asymmetry in the anterior scleral geometry in both eyes by using the profilometer eye surface profiler (ESP, Eaglet Eye), with a difference between nasal and temporal sagittal heights of 470 and 170 µm in right and left eyes respectively. Although this profile suggested the need for the fitting of a CL with significant peripheral toricity, we followed the manufacturer's guidelines and performed a trial with a CL of moderate peripheral toricity (125 µm of difference between steep and flat meridian). The stability of the CL failed again and finally a CL with a peripheral toricity close to that measured with the profilometer was fitted. With this lens, good visual performance, lens stability, and comfort was obtained and maintained during a 1-year follow-up. This case suggests that fully scleral CLs fitting might be optimized with the use of corneo-scleral profilometers, minimizing potentially the number of trials. This potential benefit should be investigated further in future studies.

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First Experience With the ICD 16.5 Mini-Scleral Lens for Optic and Therapeutic Purposes

Abstract: The present findings suggest that the ICD 16.5 mini-scleral GP lens is an effective and safe alternative for managing challenging corneas in a therapeutic impasse.

Cited by 21 publications

References 25 publications

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

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

Scleral Lens Issues and Complications Related to Handling, Care and Compliance

Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus

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