Welcome to the first issue of the Scleral Lens Monthly newsletter! This newsletter is beyond exciting as it is all about scleral lenses. It is a time of tremendous growth of scleral lens technology and the utilization of that technology. This is a thrilling time for scleral lenses with the escalation of scleral lens information in journals, conferences, webinars and beyond. Scleral lenses in my practice have been a positive life changing experience for many of my patients. It is also an emotional time for patients and practitioners alike. Seeing the smiles and sharing the tears of joy with my patients is why I love working with scleral lenses. Scleral lenses have demonstrated a significant improvement in quality of life for patients who had failed or are intolerant to conventional rigid gas permeable contact lenses.1 In a study that assessed the satisfaction of scleral lenses compared to other contact lens modalities in a keratoconus population, scleral lenses were extremely well accepted and demonstrated improved comfort and vision.2 Practitioners that have embraced scleral lens technology have in turn generated tremendous success and growth of their practices.
Scleral lenses have existed for centuries, longer than any other type of contact lens. They were first conceptualized by Leonardo DaVinci in the early 16th century and first manufactured in Europe in the late 1800s.3 The first scleral lenses were actually blown glass scleral shells without power made in 1887 by Fredrich A. Müller and Albert C. Müller.4,5 The primary indication for these scleral lenses was to manage ocular surface disease. In 1889, Adolf Eugen Gaston Fick described the use of scleral lenses with optics added to correct vision.6 In 1889, Eugene Kalt described contact lenses as orthopedic appliances in the treatment of keratoconus.7 In that same year August Müller created a scleral lens for himself to correct his own 14D of high myopia.8
Previous shortcomings included lens induced corneal edema due to poor transmissibility of oxygen through the lens, which led to the discontinuation of lens wear due to corneal hypoxia. Additionally, each lens was made by hand and impossible to replicate in the instance of breakage or loss.
Fast forward to modern scleral lenses. Accessible technology includes scleral lens materials that are hyper-permeable to oxygen, precise computer driven lathes and improved fitting techniques. Many scientific studies have established the success and benefits of wearing scleral lenses.9 Longstanding scleral lens benefits include protecting the fragile ocular surface from exposure and providing exceptional vision with rigid optics while obtaining excellent comfort.
The indications for scleral lenses are immense. These include primary and secondary corneal ectasias such as keratoconus, post-corneal transplants, corneal scars, and corneal dystrophies or degenerations including Salzmann’s nodular degeneration. Scleral lenses can be utilized in patients with severe dry eyes, graft versus host disease, Sjögren’s disease, Stevens-Johnson syndrome, neurotrophic keratopathy, or chronic inflammatory conditions such as limbal stem cell deficiency or ocular cicatricial pemphigoid. Patients are now enjoying healthy lens wear and great vision with similar comfort to that of a soft contact lens. Clearance is a key advantage to scleral lenses. The cornea is bathed all day long with saline, which rejuvenates the ocular surface. This is unlike other types of contact lenses (including soft and corneal gas permeable lenses) that may compromise the ocular surface.
As the technology and designs of scleral lenses continue to evolve, so have scleral lens fitting and the types of patients that are now considered candidates for scleral lenses. Patients with healthy eyes and normal corneas are now also excellent candidates, especially when their visual needs exceed typical soft lens parameters. Stay tuned for next month – scleral lenses for the healthy eye.
1. Picot C, Gauthier AS, Campolmi, N, et al. Quality of life in patients wearing scleral lenses. J Fr Ophtalmol. 2015 Sep;38(7):615-9. doi: 10.1016/j.jfo.2014.10.018. Epub 2015 May 20.
2. Bergmanson JP, Walker MK, Johnson LA. Assessing Scleral Contact Lens Satisfaction in a Keratoconus Population. Optom Vis Sci. 2016. Aug;93(8):855-60.
3. Bowden, T. J. (2009) Contact Lenses; The Story. Bower House Publications ISBN 978-0-9558981-0-5
4. Müller, F. A. and Müller, A. C. (1910) Das Kunstliche auge, pp. 68–75. Wiesbaden: J. F. Bergmann
5. Müller FE. (1920) Ueber die korrektion des keratokonus und anderer brechungsanomalien des auges mit müllers-chen kontaktschalen. Inaugural Dissertation. University of Marburg
6. Fick, AE. (1888) A Contact Lens (trans. C. H. May). Arch. Ophthalmol. 19, 215–226
7. Pearson RM. Kalt, Keratoconus and the Contact Lens. Optom Vis Sci. 1989 Sep;66(9):643-6.
8. Müller, A. (1889) Brillengläser und hornhautlinsen. Inaugural Dissertation p. 20. University of Kiel
9. Schornack MM. Scleral Lenses: A Literature Review. Eye Contact Lens. 2015 Jan;41:3-11.
Dr. Melissa Barnett is a Principal Optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. Dr. Barnett is the Past President of The Scleral Lens Education Society. She lectures and publishes extensively on topics including dry eye, anterior segment disease, contact lenses and creating a healthy balance between work and home life for women in optometry.