With the imminent New Year, it is time for reflection and an occasion to set intentions for your scleral lens practice and the entire scleral lens field. Scleral lenses help patients to completely restore vision, improve functionality and improve their quality of life.1-3 Whether scleral lenses are used for advanced corneal irregularity or significant ocular surface disease, they can provide significant improvement of the ocular condition for not just the patient, but entire families as well.4
Reflecting on this past year, there were so many notable and amazing scleral lens accomplishments and publications. A few of my personal favorites – a woman who lost vision from a fence wire snapping in her right eye with subsequent ruptured globe, endophthalmitis, status post lens extraction and corneal transplantion. With a scleral lens, 20/20 vision was obtained. The stories she relayed of how the scleral lens improved her vision and her life in general warmed my heart. Another favorite – a man with severe dry eyes, limbal stem cell deficiency and a history of a persistent epithelial defect in his left eye, glaucoma status post multiple glaucoma surgeries with blebs both eyes, status post lens extraction both eyes and status post DSEK in the right eye. He had previously tried a multitude of treatments and presented wearing a bandage contact lens in his left eye. A diagnostic scleral lens was fit for the right eye and an impression based scleral lens was fit for the left eye. Good comfort, fit and vision was achieved, 20/25 in the right eye and 20/25-2 in the left eye. He is beyond thrilled with his scleral lenses and only wishes that he was fit sooner.
Reflecting on your scleral lens practice, is there anything that you would do differently? Are you interested in incorporating scleral topography? Is there a scleral lens design that you would like to include in your practice? Do you want to streamline your scleral lens fitting or subsequent visits? Does publishing a peer reviewed manuscript on an aspect of scleral lenses appeal to you? In Scleral Schism, a recent publication in Contact Lens and Anterior Eye, a pubmed search was performed of the yearly publication rate of scleral lenses (n = 340)4 (Figure 1). The zenith in publications is quite remarkable. Never underestimate the power of your scleral lens intentions. Consider all of the opportunities to better the lives of our patients and improve our specialty with scleral lenses.
Fortunately, this is an exciting time in the scleral lens world to collaborate as a scleral lens community. The special edition on scleral lenses will be published January 2019 in Contact Lens & Anterior Eye. The Global Specialty Lens Symposium is January 24-27 in Las Vegas, NV (US), The International Congress of Scleral Contacts is July 25-26 in Fort Lauderdale, FL (US) and the International Summit of Specialty Contact Lenses is in Rome, Italy September 21-22, to name a few upcoming meetings that highlight scleral lenses.
For the specialists, manufacturers and staff that improve the lives of our patients, continue to "listen to the rhythm of your own calling, and follow that". Oprah Winfrey
Figure 1. Yearly publication rate of scleral lenses from the National Library of Medicine search engine (www.pubmed.com) by December 3rd, 2018 using a combination of keywords related to 'scleral lenses' and after excluding non-related references (n = 340). Courtesy Rute Juliana Ferreira Macedo de Araújo - University of Minho, Braga (Portugal) in Scleral Schism.
E. van der Worp, Scleral lenses (are) special, Contact Lens Anterior Eye 40 (2017) Oct;40(5):271-272. doi: 10.1016/j.clae.2017.07.006.
Picot, C, Gauthier, AS, Campolmi, N, Delbosc B. J Fr Ophtalmol. 2015 Sep;38(7):615-9.
van der Worp E, Johns L, Barnett M. Scleral Schism. Cont Lens Anterior Eye. 2018 Dec 1. pii: S1367-0484(18)30995-0. doi: 10.1016/j.clae.2018.11.004. [Epub ahead of print]
Dr. Barnett is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Alden Optical, Allergan, Bausch + Lomb, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Ocusoft, Paragon Bioteck, RaayonNova, ScienceBased Health, Shire, SynergEyes, and Visioneering Technologies.