Looking for contact lenses that provide clear vision and comfort both for dry eyes or irregular corneas? Discover scleral lenses, the game-changer, and a revolutionary solution in eye care.
Scleral lenses can be defined as large-diameter, rigid-gas permeable lenses that are supportedexclusively by the sclera, fully clear the limbus, and exhibit measurable vaulting over the cornea that maintain a fluid reservoir between posterior surface of lens and anterior surface of cornea. [1 and 2] The scleral has characteristic fitting feature that enables protection of ocular surface and provide continuous hydration to the ocular surface. [1] Scleral lenses due to their large optical zone diameter offer stable vision, better comfort and less lens awareness than corneal lenses. Additionally, their design extends well into the fornices, minimizing interaction with the eyelids. [2]
BENEFIT OF SCLERAL LENSES
Scleral lenses are excellent choice of lenses for irregular corneas, ocular surface disorders, etc because of the unique features it offers. The features are:
Larger diameter/size of lenses
Promote healing and comfort via constant hydration of ocular surface
Ideal for hard fit eyes which are very sensitive
Highly stable lenses that provide clear visual experience
Ideal choice of contact lenses for high corneal irregularities and severe dry eyes
CLASSIFICATION OF SCLERAL LENSES
Source: Classification of RGP contact lenses, from " A Guide to Scleral Lens fitting, 2nd Edition"
The Scleral Lens Education Society proposed standard nomenclature (in June 2013) based on fitting characteristics. The scleral lenses are classified as: lenses that rest entirely on the cornea are corneal lenses; lenses that rest on both cornea and sclera are classified as corneo-scleral lenses; lenses that overly on sclera and supported by conjunctival tissue, and vault the cornea and limbus are known as scleral lenses. Further distinctions within the category of scleral lenses define mini-sclerals as lenses up to 6 mm larger than the horizontal visible iris diameter (HVID) and full sclerals as lenses more than 6 mm larger than the HVID. [3]
INDICATIONS OF SCLERAL LENSES
Recent evidence based studies suggests that scleral lenses play a crucial role as a therapeutic choice for ocular surface diseases that do not respond well to standard lenses. [4] Based on multiple literature reviews [3, 4 and 5], the indications of scleral lens includes:
Irregular astigmatism
Keratoconus
Keratoglobus
Post traumatic
Penetrating keratoplasty
Pellucid Marginal Degeneration
Post refractive surgery
Post corneal ulcer
Post herpetic infection
Corneal dystrophies
Salzmann Nodular Degeneration
Sports persons/Athletes
Corneal Gas-Permeable contact lenses
Poor contact lens centration
Poor contact lens stability
Severe dry eye
Sjogren’s syndrome
Filamentary keratits
Limbal stem cell deficiency
Therapeutic indications
Chemical burns
Ocular pemphigoid
Exposure keratitis
Steven Johnson Syndrome
Graft vs Host disease
Neurotrophic keratopathy
Persistent epithelial defects
Keratoconjunctivitis
Cosmetic
Aniridia
Iris coloboma
Microphthalmos
Lagophthalmos
References:
1. Schornack MM, Pyle J, Patel SV. Scleral lenses in the management of ocular surface disease. Ophthalmology. 2014 Jul;121(7):1398-405. doi: 10.1016/j.ophtha.2014.01.028. Epub 2014 Mar 14. PMID: 24630687.
2. Schornack MM, Patel SV. Scleral lenses in the management of keratoconus. Eye Contact Lens. 2010 Jan;36(1):39-44. doi: 10.1097/ICL.0b013e3181c786a6. PMID: 20009945.
3. Sharma N, Sah R, Priyadarshini K, Titiyal JS. Contact lenses for the treatment of ocular surface diseases. Indian J Ophthalmol. 2023 Apr;71(4):1135-1141. doi: 10.4103/IJO.IJO_17_23. PMID: 37026245; PMCID: PMC10276751.
4. Jacobs DS. Update on scleral lenses. Curr Opin Ophthalmol. 2008 Jul;19(4):298-301. doi: 10.1097/ICU.0b013e328302cc4f. PMID: 18545010.
5. International Association of Contact Lens Educators (IACLE) modules
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