Scleral lens fitting has so many qualities that I absolutely love. I love being able to dramatically improve the lives of patients and their families with this amazing technology. I adore giving the gift of vision and comfort with scleral lenses. It is a joy to be able to offer a management solution for a multitude of different ocular and systemic conditions. It is fun playing with new scleral lens designs, technologies, and solutions as they are introduced. I cherish the relationships that I have developed over the years in the scleral lens community with practitioners and industry professionals.
However, I have also experienced some frustrations with scleral lenses and have always wondered whether other practitioners have as well. I reached out to the experts to ask their opinions.
There were numerous answers to the question about what other eyecare practitioners find "joyful" about scleral lenses. Jeff Sonsino, OD, enjoys the "ability to customize exactly to the needs of all patients." Damon Ezekiel, BOptom, appreciates giving patients a "normal life" by offering this terrific modality. In fact, he recommends a diagnostic fitting with scleral lenses so that patients can experience the amazing comfort and vision, "which is out of this world." According to Muriel Schornack, OD, "scleral lenses can be life-changing!" in patients who have so few other options. Barry Eiden, OD, echoed this sentiment; he says that scleral lenses "can be life-changing for many patients by providing exceptional vision, comfort, and ocular health response when no other vision correction options can. We change patients’ lives!" Tom Arnold, OD, enjoys directly improving the lives of patients and helping manage a "huge variety of corneal conditions," because there is always something new to see. Dr.
Ken Pullum, FC Optom DipCLP, loves the hugs that he receives from patients. Finally, according to Daddi Fadel, DipOptom, scleral lenses "gave me perspective on the value of life and the importance of contributing to making life better. I realized that there is a difference between a good life and a bad life—I realized that I am the one who stands between it."
Subsequently, I asked practitioners what they do not enjoy about scleral lenses. Cost and reimbursement were common concerns. Specifically, there is much frustration with obtaining authorization and reimbursement from insurance companies. Informed consent and cost negotiations are also concerns. According to Dr. Eiden, cost precludes patients from experiencing this option in some cases. He continues: "They are often medically indicated and necessary, and often medical insurance either won’t cover them or will reimburse at rates that make them impossible for patients to use without significant out-of-pocket expenses."
Handling is another common problem of scleral lenses. Even when a scleral lens is perfectly fit with optimal vision, if a patient cannot apply and remove the lens, it will not be wearable. Muriel Schornack, OD, reports that calls from patients regarding handling during the first four to six weeks of wear can be a nuisance. "Some patients become very impatient with themselves when they are not immediately able to master application and removal." Excellent resources for handling are available on the Scleral Lens Education Society website at https://sclerallens.org and on the Gas Permeable Lens Institute website at https://www.gpli.info.
Despite these issues, all of the practitioners with whom I spoke agree with me that scleral lenses change lives and that the benefits definitely outweigh the frustrations.
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, Bruder, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Ocusoft, Paragon Bioteck, RaayonNova, ScienceBased Health, Shire, SynergEyes, and Visioneering Technologies.