Scleral lens fitting and assessment strategies

Harthan, Jennifer; Shorter, Ellen; Nau, Cherie B; Nau, Amy; Schornack, Muriel; Zhuang, Xiaohua; Fogt, Jennifer Swingle

doi:10.1016/j.clae.2018.10.020

Cited by 19 publications

(17 citation statements)

References 30 publications

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“…The varying degrees of FR thickness have clinically significant impact on visual and optical performance which require better understanding. The most frequently suggested amount of central corneal FR thickness is 150–500 microns with 100–200 microns of limbal clearance to retain good corneal health and visual performance 21 …”

Section: Introductionmentioning

confidence: 99%

Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses

Balakrishnan

Badrinarayanan

Sivaraman

et al. 2021

Ophthalmic Physiologic Optic

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Purpose To investigate the effect of varying the fluid reservoir (FR) thickness of scleral lenses (SL) on corrected distance visual acuity (CDVA), contrast sensitivity (CS) and higher‐order aberrations (HOAs) in keratoconic eyes. Methods Forty eyes with keratoconus were fitted with a diagnostic Boston Sight SL having three different FR thicknesses. CDVA, CS and HOAs were measured before and after 30 min of lens wear. An i‐Trace aberrometer and anterior segment optical coherence tomography (AS‐OCT) were used to measure HOAs and FR thickness, respectively. Results Statistically significant improvements in CDVA and CS were seen with different FR thickness lenses (p < 0.01). Baseline CDVA (0.22 ± 0.15) improved to 0.03 ± 0.06, 0.04 ± 0.07 and 0.07 ± 0.08 with low, standard and high FR lenses, respectively. Post‐hoc testing showed better CDVA with low (p = 0.006) and standard FR (p = 0.009) lenses compared to high FR lenses. Before lens wear, CS was 1.27 ± 0.27, which improved to 1.67 ± 0.11, 1.73 ± 0.12 and 1.66 ± 0.89 with low, standard and high FR lenses, respectively. Lenses with standard FR showed better CS compared with those having low (p = 0.009) and high FRs (p < 0.001). A statistically significant reduction of higher order‐root mean square aberrations (HO‐RMS), coma, spherical aberration, secondary astigmatism and trefoil were found with all FR thickness lenses compared to baseline (p < 0.01). No significant difference was noted between lenses (p = 0.01). All three lenses corrected almost equal amount of HOAs. A moderate positive correlation was observed between CDVA and HO‐RMS (r = 0.61, p < 0.001) for low FR lenses. Conclusions BostonSight SCLERALs were found to be very effective in improving vision, CS and reducing HOAs in keratoconus. Lenses with varying FR thickness showed equal effectiveness in visual performance and reducing HOAs. FR thickness should be considered an important factor to provide better vision and CS by minimising HOAs, as well as to maintain the normal physiology of eyes with keratoconus.

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Section: Introductionmentioning

confidence: 99%

Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses

Balakrishnan

Badrinarayanan

Sivaraman

et al. 2021

Ophthalmic Physiologic Optic

View full text Add to dashboard Cite

show abstract

“…This exercise was, in large part, instigated from the dilemma that we often experienced during our clinical practice, both during intra-person assessment of same lens fitting in separate sessions as well as inter-person assessment of same lens fitting during a single session. This circumstance was quite aptly supported by the recent report from the SCOPE study group, distinctly illustrating a sense of ambiguity between practitioners, both in terms of selection as well as assessment of scleral lens parameters 11 . The rate of complications after scleral lens wear has reduced over the years mainly due to a significant improvement in contact lens materials and designs.…”

Section: Discussionmentioning

confidence: 84%

“…Central lens clearance has long been speculated as a causative factor for a reduction in the amount of oxygen reaching the underlying corneal surface. Recent work by Harthan et al has clearly demonstrated the lack of harmony in terms of selection of scleral lens vault 11 . Report by Compan and colleagues have showed the difference in corneal swelling in mini scleral lens user (15.5 mm) having a shallower post lens tear thickness (1.6%), vis-à-vis, deeper reservoir (3.9%) 14 .…”

Section: Discussionmentioning

confidence: 99%

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A multi-parameter grading system for optimal fitting of scleral contact lenses

et al. 2022

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Background: While scleral lens practise has improved over the years due to factors such as availability of lenses with better materials and designs as well as experience of practitioners, a lack of objectivity appears to remain in terms of assessment of scleral lens fitting. This prospective observational work aimed to achieve standardization on this front through proposing a grading system for scleral lens fitting. Methods: After application of prosthetic replacement of ocular surface ecosystem (PROSE) devices on the participants’ eyes, four fundamental components for understanding scleral lens fitting such as central and limbal corneal clearance, mid-haptic compression, and alignment of lens edge over anterior sclera were assessed through a series of slit-lamp biomicroscopy imaging as well as with anterior segment optical coherence tomography. FitConnect® was used to modify the device parameters to simulate different grading patterns on the proposed scale. Serial imaging was done for all the different lenses to compose the grading scale. Results: A clinically relevant grading scale was constructed that pictorially demonstrated grades for the different aspect of scleral lens fitting. The grades were conveniently scaled within three categories: “optimal”, “acceptable” and “not acceptable”. Conclusion: The gradation of scleral lens fitting parameters would take a step towards objectifying the assessment patterns in practise. This will also help reducing the gap between a novice and an experienced practitioner in terms of understanding of scleral lens fitting.

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“…In addition, there is no consensus on what is considered an ideal scleral lens fit by practitioners, 7 with conflicting studies showing reduced midday fogging when scleral lenses are fit to match the exact scleral curvature, 8 and other studies finding that lenses fit less tightly and therefore promoting tear exchange had longer periods of wear without midday fogging (McKinney et al IOVS 2013;54:ARVO E-Abstract 5483).…”

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confidence: 99%

Changes in Symptoms of Midday Fogging with a Novel Scleral Contact Lens Filling Solution

2020

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SIGNIFICANCE Midday fogging of scleral contact lenses requires frequent lens removal and reapplication for a large portion of lens wearers. Using a lens filling solution that mimics the composition of tears is hypothesized to have an impact on the production of material trapped under a scleral lens. PURPOSE The purposes of this open-label study were to assess the safety of a scleral lens filling solution, which closely approximates the ionic concentration and pH of human tears, and to assess signs and symptoms of midday fogging with this formulation and with subjects' habitual sodium chloride solutions. METHODS Existing scleral lens wearers with midday fogging (N = 22) were examined and completed surveys of symptoms. Subjects filled the concavity of their current lenses with test solution and were assessed immediately and approximately 4 hours later for safety monitoring. Test solution was dispensed and used for 5 to 9 days when subjects were reexamined and repeated the surveys. Biomicroscopy and anterior optical coherence tomography images were used to assess midday fogging objectively. RESULTS The median (interquartile range) Ocular Surface Disease Index score decreased from 27.1 (21.7) U when using habitual filling solution to 9.1 (20.1) U when using the test solution ( P = .006). Current Symptoms Survey findings with the test solution compared with habitual solution resulted in statistically significant decreases in burning/stinging ( P = .04), grittiness/foreign body sensation ( P = .01), dryness ( P = .002), blurry/fluctuating vision ( P = .002), and overall pain/discomfort ( P = .006). Objective assessment of corneal staining and fogging revealed decreases that were not statistically significant in this small sample size. CONCLUSIONS This study establishes the safety and subject tolerance of a scleral lens filling solution that mimics the ionic composition of human tears. Significant improvements in subjective ratings, although likely biased in this unmasked trial, suggest that further studies of the effectiveness of this solution in reducing midday fogging are warranted.

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Scleral lens fitting and assessment strategies

Cited by 19 publications

References 30 publications

Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses

Fluid reservoir thickness and aberration relationship in keratoconic eyes with scleral lenses

A multi-parameter grading system for optimal fitting of scleral contact lenses

Changes in Symptoms of Midday Fogging with a Novel Scleral Contact Lens Filling Solution

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