Scleral lenses continue to become more popular in the specialty lens industry for managing corneal irregularity and ocular surface disease. It is hard to imagine that anyone 20 years ago would have predicted that scleral lenses would reach their current level of use with patients who have irregular or regular corneas.
Recent data from the SCOPE study (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) have been reported that put modern scleral lens fitting into a useful frame of reference. A 19-question survey was sent to more than 4,500 individuals, including members of the Scleral Lens Education Society, the American Academy of Optometry, the American Optometric Association, and the Contact Lens Association of Ophthalmologists, over a three-month period in 2015. The SCOPE survey was able to generate 989 responses, including 732 practitioners who have fit five or more lenses, for a total of 84,375 patient fits.
Demographic analysis from the SCOPE data shows that practitioners of all ages and practice settings are using scleral lenses (Nau C. et al, 2016). Fifty-eight percent of respondents fitting scleral lenses were from group or private practice, while 27% practiced in an ophthalmology or academic setting.
The majority of lens fitters (77%) reported fitting their first scleral lens after 2006 (Figure 1), and most lens fitters report fitting five or fewer lenses per month. The most prolific fitters reported fitting 100 to 150 per month! It will be interesting to see whether this accelerated growth curve continues over the course of the next 10 years, including more practitioners using scleral lenses and more lenses fit per practitioner.
Scleral Lens Indications
Although the use of scleral lenses has expanded to include refractive applications; ocular surface disease; and disorders of the cornea, mucous membrane, and lid, fitting scleral lenses to manage corneal irregularity, in particular for keratoconus, remains the most common reason for clinicians to fit a scleral lens (Nau A. et al, 2016). A potential area of growth could be the use of scleral lenses for patients who have been unsuccessful in soft contact lenses secondary to high refractive error or dryness. SCOPE analysis shows that corneal GP lenses are currently the most commonly prescribed lens for corneal irregularity (Shorter et al, 2016); however, the increased use of scleral lenses could result in their surpassing corneal GP lenses as a first-choice option when managing corneal irregularity.
A Growing Modality
Early adopters of scleral lenses who have embraced their use for specialty fitting have started a resurgence of this lens type. A tipping point has certainly been reached that is making scleral lenses more mainstream. Although enhanced designs and technology continue to improve scleral lenses, education and training for practitioners new to them is paramount for continued growth and success. CLS
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Dr. DeNaeyer practices at Arena Eye Surgeons in Columbus, OH. He is a shareholder of Precision Ocular Metrology LLC, has proprietary interest in Visionary Optics’ Europa and Elara Scleral Lenses, and is a consultant to Visionary Optics and Alcon. You can contact him at firstname.lastname@example.org.