A study at University Medical Center Utrecht assessed the performance of multiple lens modalities for a wide range of medical indications.1
This prospective cross-sectional study evaluated 281 existing contact lens patients fit with lenses based on a lens selection algorithm. Soft lenses and scleral lenses were two of the most commonly prescribed lens designs in this Netherlands study.
Surprisingly, despite the various corneal pathologies and conventional clinical wisdom, both soft and scleral lenses scored similarly in lens performance and patient satisfaction.
Visser et al determined that wearing contact lenses significantly improved corrected distance visual acuity and quality of life. Additionally, the authors went on to propose that scleral lenses are valid treatment choices after soft lenses fail to achieve desired visual rehabilitation in study patients.1
We have witnessed a rise in clinical utilization of scleral lenses in recent years, and in some cases, their clinical indications have expanded to include even those patients with regular corneas. Given this sharp rise in scleral lens utilization, the principle of lens selection continuum as proposed by Visser et al appears to also hold true in patients with normal healthy eyes. Thus, when should clinicians reach for scleral lenses when providing care to patients with regular corneas?
Looking at scleral lenses
Scleral lenses are large-diameter gas permeable (GP) contact lenses designed to vault over the cornea and rest on the scleral conjunctiva with minimal to absent pressure exerted along the corneal limbal region (Figure 1).
Subsequently, a scleral lens is able maintain a sizable fluid interface connecting the posterior optical zone to the corneal plane, which allows for neutralization of regular and irregular corneal astigmatism, and also provides therapeutic protection to the underlying ocular surface.
In recent years, owing to modern manufacturing processes and the availability of highly oxygen-transmissible lens materials, scleral lenses have further expanded their clinical indications. These lenses are now able to provide excellent vision and comfort for patients with corneas that are of normal, prolate profile with or without concomitant conditions like meibomian gland dysfunction, blepharitis, or dry eye.