Pediatric and Teen CL Care
Full Scleral Versus Mini-Scleral Lenses for Children
BY MELANIE FROGOZO, OD, FAAO
Scleral lenses have many therapeutic benefits, which make them worth offering to young children. The type of scleral lens you choose for a pediatric patient is based on the condition you are treating and what works best for the patient’s lifestyle.
When to Choose a Full Scleral
Full scleral lenses are larger than 18.0mm in size. Kids who have ocular surface disease and severe dry eyes can benefit from wearing full scleral lenses. These young patients need protection over as much of the eye as possible, so I usually fit them with the largest size lens that I can get on their eye. A full scleral lens can usually fit on eyes of patients older than 6 months of age.
A Situation that Warranted a Full Scleral Lens A 5-year-old girl diagnosed with congenital corneal anesthesia was fitted into an 18.2mm scleral lens to keep her cornea from breaking down. Typically, these patients present with chronic punctate keratopathy and, if left untreated, can progress to persistent epithelial defects and corneal ulceration. Their eyes need constant lubrication to keep the ocular surface from breaking down. The scleral lens acts as a “liquid bandage” that will continually lubricate the eye and protect it at the same time.
Because the surface of the whole eye is dry, a full scleral lens that covers as much of the surface as possible is best. Therefore, fit children who have severe ocular surface disease and dry eyes in a full scleral lens when possible.
When to Choose a Mini-Scleral
Mini-scleral lenses range from 15.0mm to 18.0mm in size. These lenses are great for young children who have normal corneas with high refractive errors as well as for those who have irregular corneas such as keratoconus. Mini-sclerals are also good choices for kids who are intolerant to corneal GP lenses and want comfort similar to a soft contact lens. In addition, the smaller size of mini-sclerals makes it easier for children to handle the lenses and to learn how to apply and remove them.
A Situation that Warranted a Mini-Scleral Lens A 10-year-old girl who has high hyperopia and astigmatism (+9.50 −4.50 x180 in both eyes) was fitted into a 15.5mm mini-scleral lens. I first tried a custom soft toric lens for this patient, but her vision was poor due to excessive rotation, and she ripped the lenses a few days after dispense. In this case, mini-scleral lenses were a good choice because they are just as comfortable as soft lenses, but because of the rigid material, you don’t have to worry about the lens ripping or folding during application and removal.
Additionally, the GP optics simplify this type of prescription by making it spherical, so you don’t have to worry about lens rotation. This patient easily learned how to apply and remove her mini-sclerals and is doing great.
Wrapping It up
Don’t hesitate to offer scleral lenses to your pediatric patients. Table 1 shows a simplified breakdown of which scleral lenses I offer to my young patients and why. CLS
|Full Scleral Lenses (18.0mm+)||Ocular surface diseases or dry eyes; children who need maximum protection of the eye.|
|Mini-Scleral Lenses (15.0mm to 18.0mm)||Regular or irregular corneas; children who could benefit from GP lens optics or who are intolerant to corneal GP lenses.|
Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. You can contact her at firstname.lastname@example.org.