Visual and Physiological Outcomes of Scleral Lens Wear
Melissa Barnett, OD, FAAO, FSLS, FBCLA
"Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has."– Margaret Mead
This is the essence of the scleral lens community. Although scleral lenses are growing at a rapid pace, not every practitioner fits scleral lenses. It is a relatively small, but expanding, group of dedicated practitioners that are improving the lives of patients with scleral lenses.
Scleral lenses have demonstrated significant improvement in the quality of life for patients who had failed or were intolerant to conventional rigid gas permeable contact lenses and may be an alternative or a step prior to surgery.1
A recent Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) study publication evaluated visual and physiological outcomes of scleral lens wear.2 In totality, 292 practitioners from 26 countries responded to the survey. Corneal irregularity (87%) was the most common reported indication for scleral lens wear followed by ocular surface disease (8%), refractive error (4%) and multiple indications (1%). Visual acuity improved in eyes with corneal irregularity, ocular surface disease and refractive error. Prior to scleral lens wear, 55% of patients had corneal staining, compared to 35% of patients after scleral lens wear. The number of topical ophthalmic drops needed decreased in both groups, 1.7 ± 0.9 to 0.8 ± 0.8 in patients with corneal irregularity (p < 0.001) and from 3.5 ± 1.7 to 1.1 ± 1.0 in patients with ocular surface disease (p < 0.001). In those who wore scleral lenses to correct refractive error, the number of drops was similar prior to (2.0 ± 1.0 drops) and after scleral lens wear (1.7 ± 1.5 drops). The ocular surface improved in patients with both corneal irregularity and ocular surface disease, although those with ocular surface disease had the most remarkable improvement. Those fit with scleral lenses to correct uncomplicated refractive error did not experience an improvement in signs or symptoms of ocular surface disease.
Scleral lenses not only enhance the visual quality for patients, but improve the ocular surface and reduce dependence on topical medications.
Picot, C, Gauthier, AS, Campolmi, N, Delbosc B. Quality of Life in Patients Wearing Scleral Lenses. J Fr Ophtalmol. 2015 Sep;38(7):615-9.
Schornack M, Nau C, Nau A, et al. Visual and physiological outcomes of scleral lens wear. Cont Lens Anterior Eye. 2018 Aug 8. pii: S1367-0484(18)30858-0. doi: 10.1016/j.clae.2018.07.007. [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.