Download Scleral Contact Lenses That`s a BIG lens!! Size matters Average

9/24/2014
That’s a BIG lens!!
Scleral Contact Lenses
MOA Convention
10.4.2014
Chris DeRose, OD
Size matters
Average Corneal diameter = 11.5mm
Average RGP lens = 9.5 mm
Soft Contact lens = 14.0 to 14.5mm
Mini‐scleral lens = 15.0 to 18.0mm
Scleral lens = 18.0 to 24.0mm
RGP
Soft Contact Lens
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Scleral Lens
What makes Sclerals
different?
Rest on the sclera (don’t touch the cornea)
Vault over the cornea
Tear Reservoir between the contact lens and the eye
Insertion and removal process
So What?
Who is a good patient for scleral lenses?
Corneal irregularity
Corneal scarring or post trauma
Keratoconus
S/P refractive surgery
Advanced dry eye or incomplete lid closure (exposure)
S/P Corneal transplant
Extreme astigmatism
Cosmetic (albinism, trauma, aniridia)
Resurgence
Advantages
No corneal touch = no chance of worsening scar progression
No corneal contact and less movement = less awareness (kinda)
Tear reservoir can be therapeutic Better VA (sometimes dramatic)
Easier to compensate for crazy corneal shapes
Messed Up Corneas
Increased O2 permeability of new lens materials
New digital manufacturing processes
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Vault
Can we fix this cornea with scleral lens?
Corneal Topography
(normal)
Corneal Topography
(astigmatism)
Corneal Topography
(Keratoconus)
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Corneal Topography
(?)
Fitting
Fitting
Must be fit diagnostically
Alignment with sclera No bearing on limbus
Based on sagittal height
Little to no movement
Must settle for 30 minutes
No conjunctival impingement
Spherical over‐refraction
Vault Reduction
Therapeutic Sclerals
Tear Reservoir promotes healing in Ocular Surface Disease
Sjogren’s
Stevens Johnson Syndrome
Graft vs Host
Ocular cicatricial pemphigoid
Neurotrophic corneal disease Exophthalmos
Ectropion
Eyelid Coloboma
Start Steep
Minimal Vault
Touch
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Insertion and Removal
Insertion and Removal
Insertion and Removal
Insertion and Removal
Fill the lens with non‐preserved saline
Place lens on formed "tripod" (thumb, index, and middle finger) or use scleral cup
Position face parallel to a horizontal plane, typically the table/mirror and open eyelids wide using opposite hand. Insert lens edge into lower cul‐de‐sac while pushing the lens onto cornea
Must break the negative pressure underneath the lens Manual method –
Using fingers, guide eyelid margin under the bottom edge of the lens. This will break suction and allow lens to come out
Plunger method –
Place the plunger on bottom portion of lens
NEVER place the plunger centrally on lens – may result in corneal damage
Insertion and Removal
Use anesthetic for initial lens dispense
Study: Reduces long term drop outs by 75%
Patients may be intimidated by size of lens and handling – Doc presentation is the key
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Complications
Complications
Complications
Contact Lens Optics
Sagittal height
Increased sagittal height steepens corneal‐lens fit
Systemic Conditions that Affect CLs
Cosmetic Sclerals
Diabetes
Collagen Vascular Disorders
Pregnancy
Birth Control
Thyroid Eye Disease
Allergy
Anti‐histamine use
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Cosmetic Sclerals
Hollywood Sclerals
Hollywood Sclerals
Why fit scleral lenses?
Differentiate your practice
Incredibly grateful patients = more referrals
Full scope of professional practice
More referrals from Ophthalmology/cornea
Case
Case
Patient AW ‐ 55 year old Male + Severe Keratoconus OD > OS
Has been wearing Rose K lenses OU for many years
Lenses have begun to spontaneously eject
VA cCLs: OD 20/40‐ OS 20/40
BVA with specs:
20/400 OD, OS
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Case
Slit lamp: Case
Refit to scleral lens – diameter 18.0 mm
Central corneal scarring OD > OS
Significant apical thinning OU
2‐3+ central SPK OU
Refit to SynergEyes Ultrahealth hybrid CL
Poor comfort and limited wear time
Significant protein build‐up on lenses
Case
BVA cCL:
OD 20/30
OS 20/30+
16 hours of comfortable wearing time
No corneal contact on central scarring
References
ES, Barr JT, Szczotka‐Flynn LB. Keratoconus. In: Clinical Manual of Contact Lenses.
Bennett and Henry, Wolters Kluwer, 4th ed. 2014; Chapter 1: 518–577.
DeNaeyer G, Breece R. Fitting techniques for a scleral lens design. Contact Lens Spectrum. 2009; 1: 34–37.
DeNaeyer G. Scleral contact lens fitting. Contact Lens Spectrum. 2010; 6: 20–25.
DeNaeyer G, Jedlicka J, Schornack MM. Scleral Lenses. In: Clinical Manual of Contact Lenses.
Bennett and Henry, Wolters Kluwer, 4th ed. 2014; Chapter 21: 609‐647.
Eggink FAGJ, Nuijts RMMA. Revival of the scleral contact lens. Cataract & Refractive Surgery Today Europe. 2007; 9: 56–7
Jacobs DS. Update on scleral lenses. Current Opinion in Ophthalmology. 2008; 19: 298–301
Kalwerisky K, Davies B, Mihora L, et al. Boston Ocular Surface Prosthesis in the management in severe periorbital thermal injuries: a case series of 10 patients. Ophthalmology. 2012; 119: 516‐521.
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