Eyecare providers can improve the quality of life of patients who have photophobia, ocular trauma, and disfiguring congenital conditions, such as an iris coloboma, with prosthetic or tinted contact lenses after following 7 tips. This was the message provided by Amanda Dieu, OD, and Shazib Haq, OD, during their lecture at GSLS 2026.
1. Build a Trial Lens Set
A small in-office set dramatically improves accuracy, the lecturers explained. This set should include black annular lenses in multiple pupil sizes (3 mm to 5.5 mm), fully occlusive black lenses, and tinted diagnostic lenses (red, amber, gray-green, brown). The set should also contain clear, large-diameter “blank” 16 mm to 22 mm scleral-appearance lenses for custom-painted scleral cases. These lenses are needed to assess glare, photophobia, diplopia reduction, evaluate centration, rotational stability, and movement, and to test the patient’s acceptance of occlusion before custom designs are ordered, Drs. Dieu and Haq explained.
2. Assemble an “Iris Decentration” Kit
This should be comprised of a narrow-beam transilluminator and fine-tip permanent markers for marking fixation points on blank lenses in patients who have phthisis bulbi, microphthalmos, or traumatic displacement, explained the lecturers.
3. Create a Complex Cases Protocol
To prepare for challenging cases where the patient has diplopia, Drs. Dieu and Haq suggested trialing fully occlusive lenses, assessing symptoms, and considering a 2-lens system (social vs functional). In cases where a piggyback lens (soft prosthetic + scleral) is required, the lecturers recommended using a high-Dk silicone hydrogel daily lens beneath the scleral lens, verifying alignment with fluorescein and ocular coherence tomography if available, and instructing the patient to limit wear to 1x to 2×/week initially.
4. Determine the Patient’s Goal(s)
When the patient presents interested in prosthetic or tinted contact lenses, have a conversation with them about their one or more goals with the lenses. This is to ensure that both the eyecare provider and patient are on the same page: “Are we restoring cosmesis, improving vision, or managing comfort?” the lecturers stressed to attendees.
5. Assess Ocular Characteristics
Be sure to determine pupil size in scotopic and photopic conditions, acquire iris diameter measurement, and check ocular surface health (with grading), Drs. Dieu and Haq said. Additionally, they emphasized the importance of pretreating ocular surface disease (ie, meibomian gland dysfunction and superficial punctate keratitis) prior to lens fitting and employing corneal topography and pachymetry for grafted or irregular corneas.
6. Dispense and Educate
When providing the patient with their new contact lenses, teach them about the importance of following the prescribed wear and care schedule, assess their over-refraction, and review with them the signs of giant papillary conjunctivitis and pigment degradation, so they can contact you to intervene, explained the lecturers.
7. Follow-Up
Plan on a follow-up schedule of 1 week, then 1 month, then 3 months to check for and treat corneal edema, conjunctival injection, pigment lifting, and lens adherence (especially in grafted corneas), pointed out Drs. Dieu and Haq.