When should I consider a scleral lens, and how can my consultant help me with these cases?
“Scleral lenses are a great option for many patients. I would consider using them on almost anyone with the motivation to wear them. From irregular cornea patients to dry eye patients and previous soft lens wearers who are looking for something to give them better comfort and vision, scleral lenses can be beneficial. A consultant can help from start to finish. We can provide you with a fitting set and fitting guide to help with the initial fitting, as well as explain what you are looking for in a good scleral lens fit. Once the initial fitting is done, a consultant can help take your findings and make the appropriate adjustments to the lens to order.” (Kelsey Roberts, Valley Contax)
“Scleral lenses are a very good choice for patients who have been failures in other modalities in the past, have extremely irregular corneas, have untreatable dry eye issues, and have comfort and/or visual issues with other lens designs. Extreme irregularity of the cornea and advanced pellucid marginal degeneration are just a couple of the cases for which scleral lenses should be the lens of choice.” (Jim Slightom, ABB Concise)
“The recent development of scleral lenses has enabled practitioners to fit a wide range of difficult corneal issues successfully, including but not limited to keratoconus, PMD, corneal grafts, corneal scars, and post-surgical problems. These large GP lenses provide excellent patient comfort and acuity and are an excellent alternative to corneal lenses for these difficult-to-fit patients.” (Ann Shackelford, ABB-Concise)
“The prevailing thought on sclerals runs from ‘use a scleral first’ to ‘use a scleral as the last resort.’ Regardless of these thoughts, I recommend sclerals whenever GP intolerance is the issue. Most patients can be fit with a scleral design, so that is not the issue. The fitter must decide if the extra cost, insertion and removal issue, and handling a large-diameter GP are worth it to the patient and fitter. The laboratory consultant can provide experience with these designs and, in most cases, loaner trial sets to fit patients.” (Al Vaske, Lens Dynamics Corporation)
“When other options are obviously not working and you decide that it is better to get off the cornea entirely, the scleral lens is your best option. Our consultants have been fitting thousands and thousands of sclerals since 2006 and know all the ins and outs of changing the designs when necessary to provide you with the perfect fit. The uniqueness of the eyes being fit dictate that many times it will take a unique fit to do the best job possible. The scleral lens chosen needs to have the ability to change the heights over all of the different areas of the cornea at will and control all of the heights separately for your best success with sclerals. As with all other types of lenses, there is no ‘one size fits all’ in the scleral arena.” (Jeff Birk, Essilor)
What resources can help increase my knowledge about scleral lens designs?
“You can check the website of your CLMA member laboratory. Here are organizations I recommend:
Great meetings where you can obtain experience include:
“Great webinars exist on almost all the designs today, many meetings are offered throughout the year on scleral lens fitting, and most consultants are well versed on fitting these lenses.” (Jim Slightom, ABB Concise)
“Each manufacturer offers excellent training materials on their websites. Also the manufacturers’ consultants would be my ‘go to’ for any assistance.” (Susan Faul, Paragon Vision Sciences)