HOW TO INCORPORATE SCLERAL LENSES INTO YOUR PRACTICE
EDWARD S. BENNETT, OD, MSEd, FAAO
Scleral lenses—notably mini-sclerals—have virtually exploded into contact lens practice in the past decade. Eyecare practitioners (ECPs) are adopting them—initially for their ability to improve the quality of life for many individuals who have either debilitative dry eyes or advanced forms of irregular cornea and today for astigmatic and presbyopic individuals as well. According to the Scleral Lenses in Current Ophthalmic Practice (SCOPE) survey involving 84,000 wearers, 74.2% wear scleral lenses due to irregular cornea,16.1% for ocular surface disease, and 9.7% for refractive error (Schornack, 2016). Certainly, it is evident that they are becoming a preferable alternative to corneal GP lenses in irregular cornea correction due to better initial comfort, centration, better retention, and stability of vision. In part due to these reasons, sclerals may result in less referral for corneal surgery (Bennett, 2015).
Therefore, there has been an increasing number of ECPs integrating sclerals into their practice. Those not yet fitting them are, for the most part, interested due to how they can benefit their patients.
Here are resources to help ECPs feel comfortable with scleral lenses.
Scleral Lens Education Society (SLS; www.sclerallens.org) The SLS is a nonprofit organization dedicated to teaching ECPs the art and science of prescribing scleral lenses. They have downloadable resources; access to an excellent YouTube video on scleral lens application, removal, troubleshooting, and lens care; and the opportunity to participate in hands-on workshops at national, regional, and local symposia. In addition, there exists the opportunity to become a Fellow of the SLS and to be listed on its website as a Scleral Lens Fitter; this list is accessible to the public.
GP Lens Institute (GPLI; www.gpli.info) The GPLI has numerous resources pertaining to scleral lenses, most notably no less than 15 archived webinars from the leading U.S. scleral lens fitters on all areas of scleral lens design, fitting, troubleshooting, and care. In addition, there is an entire module, developed by Dr. Clarke Newman, pertaining to specialty lens coding and billing.
A Guide to Scleral Lens Fitting (2nd Edition) by Eef van der Worp, BOptom, PhD, FAAO This 68-page guide is likely the premier written resource on how to design, fit, troubleshoot, and care for scleral contact lenses. In addition, it is a free download from Pacific University College of Optometry or from the aforementioned organizations.
Scleral Lens Fit Scales (www.ferris.edu/HTMLS/colleges/michopt/vision-research-institute/pdfs-docs/Scleral-lens-fit-scales_v2.pdf) This is an extremely useful tool developed by the contact lens clinical research team at the Vision Research Institute associated with the Michigan College of Optometry. This downloadable resource is of great assistance in estimating central clearance but can also assist with the limbal clearance as well as the edge relationship to the sclera.
Your GP Laboratory Every GP laboratory fabricates one or more scleral lens designs, and no one understands the design, fitting, and troubleshooting of them better than the laboratory consultants. There is an increased use of topography, as well as iPhone adaptors to the slit lamp for taking both photos and video, being provided to consultants. In addition, scleral lens fabricating laboratories have numerous fitting resources on their websites and often provide webinars on how to fit their lens design.
The Global Specialty Lens Symposium (GSLS; www.gslsymposium.com) The GSLS features close to 100 hours of education and has a particular emphasis on scleral lenses, including seminars on specific lens designs. The next GSLS is on Jan. 26 to 29, 2017 in Las Vegas.
The benefits of sclerals should make them a mainstream contact lens correction device, which hopefully will be incorporated into every contact lens practice. CLS
For references, please visit www.clspectrum.com/references and click on document #251.
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. He is also clinical features editor for Contact Lens Spectrum. You can reach him at email@example.com.