In the past few years, scleral gas permeable (GP) contact lenses have become an integral part of the specialty contact lens practice. Uses of scleral lenses have expanded from the irregular cornea patient to many other uses, including patients with dry eye and other ocular surface conditions.
Scleral lenses provide a liquid reservoir that functions to help correct corneal irregularities and also to provide relief and healing of the ocular surface. In addition, scleral lenses prevent desiccation due to exposure and protects the cornea from trauma due to blinking.
According to the original Dry Eye Workshop (DEWS) study in 2007, approximately 5 million Americans over the age of 50 suffer from dry eyes.1
Looking at dry eye
Many patients experience contact lenses intolerance. In addition, moderate to severe dry eye, such as those patients with systemic health conditions, can be helped by scleral contact lenses. The Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) study group reported that ocular surface indications comprised 16 percent of scleral lens fits.2
Advancements in lens manufacturing technology, lens materials, corneoscleral imaging, knowledge, experience, and fitting techniques have expanded the capabilities of treating those patients with compromised corneas.
According to the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop DEWS II report, those who are symptomatic with signs of ocular surface disease may benefit from scleral lenses and show improvement in corneal punctate staining and filamentary keratitis. In addition, the DEWS II report stated that those with neurotrophic keratitis and neuropathic pain may benefit from scleral lenses.3
1. The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007 Apr;5(2):93-107.
2. Nau, CB, Harthan, J, Shorter E, Barr J, Nau A, Chimato NT, Hodge DO, Schornack MM. Demographic characteristics and prescribing patterns of scleral lens fittters: the SCOPE study. Eye Contact Lens. 2018 Sep;44 Suppl 1:S265-S272.
3. Craig, JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II definition and classification report. Ocul Surf. 2017 Jul;15(3):276-283.