Update on indications, complications, and outcomes of scleral contact lenses

Abstract

Background: The role of scleral contact lenses (SCLs) has increasingly expanded since the first lens was fitted more than a century ago. While it was initially prescribed for the management of severely compromised corneas, the indications for modern SCL use have expanded to include less severe diseases. In this review, we aimed to provide an up-to-date overview of the current indications, complications, and outcomes for the various types of SCLs.
 Methods: In this narrative review, we thoroughly searched the PubMed/MEDLINE database for literature published from January 1980 to November 2021. Only relevant up-to-date English references were included. Furthermore, the figures in this manuscript were derived from our unit’s patient documentation.
 Results: Currently, SCLs can successfully be used to manage ocular surface diseases, visually rehabilitate irregular corneas, and correct irregular refractive errors. Although newer materials have yielded the same visual outcomes with fewer complications, these consequences still occur in approximately one-third of contact lens wearers, including difficulties in insertion and/or removal, discomfort or pain, and developing either halos, blurriness, or haze. Even though most of these complications are minor and can be easily treated, a good practice is essential to avoid sight-threatening complications such as microbial keratitis.
 Conclusions: SCLs are indispensable in ophthalmic clinics. The development of better-quality SCLs has increased the number of indications and improved the achievable visual rehabilitation. The future of developing improvements in SCL design, materials, and fit, and the expansion of their indication range is promising.

Ocular surface lesions in clinical grades of Bell’s phenomenon

“…We hypothesized that weak Bell’s phenomenon is one of many causes of superficial corneal lesions. We classified Bell’s phenomenon by taking facial photographs of all patients with exposure keratopathy [ 36 ] who presented to our department within a 1-year period. Most patients with bilateral horizontal corneal lesions did not have a strong Bell’s phenomenon.…”

Chitosan-coated contact lens-based ophthalmic drug delivery system to manage Acanthamoeba keratitis: a preliminary hypothesis

“…Randomized controlled trials in healthy eyes with CLs or orthokeratology lenses to reduce the refractive error could shed more light on the clinical impact of this novel CL as a prophylactic measure in acanthamoeba keratitis. To achieve a better clinical safety profile, further studies on patients with decompensated corneas fitted with CL for visual rehabilitation (Figure 1A-D) [26] are warranted. This hypothesis introduces a concept for minimizing or eliminating vision-threatening keratitis in CL wearers.…”