Article

THE SCLERAL LENS VAULT

TEN SCLERAL LENS FITTING MISTAKES

The spectrum of scleral lens fitting experience ranges from complete novices to practitioners who now have been fitting scleral lenses for decades and have done thousands of successful fits. No matter what your experience level, learning how to manage common fitting mistakes will allow you to evolve and grow as a scleral lens practitioner.

Common Mistakes

  1. Not Fitting Enough Lenses As with any skill, you need to actively do it to improve. The learning curve for successful fitting of scleral lenses is steep, especially when using diagnostic lenses. There is no question that fitting more cases is better and will allow you to improve as you gain experience. A minimum of four fits per month is a reasonable goal.
  2. Not Bracketing When using diagnostic lenses, make sure to make larger changes initially and bracket toward the best diagnostic lens. For example, if the first lens applied is too flat, choose the next lens that is significantly steeper in sagittal height, not just the very next lens in the set. Once there is clearance, you can bracket back.
  3. Assessing the Lens Too Early After applying a diagnostic lens or a dispensed fit lens, wait at least 20 minutes before assessing the lens fit. Assessment errors can lead to unnecessary design adjustments.
  4. Not Making Significant Changes for Remakes For design adjustments of a fit scleral lens, order the next lens with significant parameter changes. Minimum changes would be ≥ 50 micron sag, ≥ 0.5mm radius curve change for peripheral curves, and ≥ 0.05mm center thickness adjustments.
  5. Not Prescribing Front-Surface Toricity A significant number of patients will improve a line or two on the chart with added front-surface toric power. Such patients may include those who have lenticular astigmatism.
  6. Not Using Photography With the availability of cell phone slit lamp adapters, everyone fitting scleral lenses is capable of photographing or taking a video of a fit. These images are invaluable to consultants when they are helping to make fit adjustments. Additionally, eyecare practitioners can use them later to help troubleshoot issues if any complications arise.
  7. Not Knowing When to Say When The objectives when fitting a scleral lens include acceptable vision, acceptable comfort, and no lens-induced complications. Don’t make changes unless they may improve these objectives. You are on the right track if you can achieve a successful fit in one to three lenses.
  8. Not Updating Technology The sophistication of scleral lens design has dramatically improved, but that doesn’t mean it has to be more difficult to fit lenses. Practitioners who are serious about scleral lens fitting should consider investing in instrumentation and technology such as optical coherence tomography, corneo-scleral topography, or molding technology. These updates will allow even novice fitters to fit like an expert.
  9. Not Educating and Re-Educating Patients on Solutions Many scleral lens complications are the result of either using the correct solutions inappropriately or using solutions that weren’t prescribed. Address solutions at every exam.
  10. Fitting Everyone in Scleral Lenses Scleral lenses have changed the way that we manage our most difficult patients, but they are not for everyone. Some of these patients, including early keratoconus patients, will be more successful in specialty soft or corneal GP contact lenses. CLS