Are Scleral Lenses Impacting Corneal Transplants?
BY EDWARD S. BENNETT, OD, MSED, FAAO
Not so long ago, conventional corneal GP designs were the only options available for managing irregular cornea patients; today, we have many more tools in our contact lens toolbox for such cases. In particular, scleral designs provide the vision of a corneal GP design with typically better comfort. Surveys have found that scleral lens use is rivaling, and even surpassing, the use of corneal GPs. Sclerals are rapidly becoming the “go to” option for irregular cornea patients (Bennett, 2014; Bennett, 2015).
We now have an option that continues to grow in popularity and that appears to keep many irregular cornea patients from being referred for a corneal transplant. So what effect is this having on the actual number of corneal transplant referrals?
Asking the Experts
This question was asked of the specialty contact lens fitters that comprise the GP Lens Institute Advisory Board. This is obviously a biased sample, as many of the most prominent U.S. scleral lens fitters are in this group. Specifically, they were asked: “What impact (if any) do you feel scleral lenses have had on your patient referrals for (any form of) corneal transplant in recent years?”
The answer choices included:
1. Moderate reduction in patient referrals for a corneal transplant.
2. Mild reduction in patient referrals for a corneal transplant.
3. No reduction in patient referrals for a corneal transplant but predict that scleral lenses will reduce the need for corneal transplants in the future.
4. No reduction in patient referrals for a corneal transplant and predict that scleral lenses will not impact the number of future corneal transplants.
Of 34 respondents, 26 believed that scleral lenses had reduced corneal transplant referrals (11 = moderate; 15 = mild); four members selected option 3, and four selected option 4. Some indicated that they did not refer very many patients for transplants before sclerals—and they still don’t. Table 1 shows some comments.
|Comments from the GPLI Advisory Board|
|“Within the ophthalmology department at the USC Eye Institute, where 90% of my patients wear sclerals, several corneal specialists have told me that they rarely need to operate on keratoconus patients because most can achieve sufficient comfort and vision with scleral lenses.” –Gloria Chiu, OD|
|“I feel that there’s been moderate reduction in patient transplant referrals. The important issue is patient quality of life. Scleral lenses have improved the quality of life of each patient with whom we have fitted them.” –Jack Schaeffer, OD|
|“Some keratoconus patients can wear scleral lenses successfully when they could not tolerate corneal GP lenses. For those who develop significant scarring, we still may recommend a transplant.” –Michael Lipson, OD|
|“Although scleral lenses have had a significant impact in delaying and/or preventing the need for surgery, the reimbursement and considerable time commitment for the surgeons have made penetrating keratoplasties less appealing to perform.” –Michael Ward, FCLSA|
Overall, however, a study looking at the impact of scleral lenses on the incidence of corneal transplants is indicated, and the results could be compelling. CLS
For references, please visit www.clspectrum.com/references and click on document #238.
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at firstname.lastname@example.org.