In our recent Scleral Contact Lens workshop, we were introduced to basic scleral lens design and application. Our presenters discussed scleral lens fitting basics and gave us tips on how to identify and troubleshoot common complications encountered when fitting scleral lenses.
Here’s a summary of what we learned:
The Indications for scleral lenses
- The primary indication for scleral lenses is for visual improvement in patients with Corneal Ectasia.
- Scleral lenses can also be used for ocular protection and visual restoration in other corneal pathologies.
- Patients with Lid/Orbit disorders can benefit from the use of scleral lenses.
- Scleral lenses are also valuable to correct refractive errors in normal corneas.
The Five-Step Scleral Lens fitting approach
- Find the initial diagnostic lens:
- Get corneal topography or K-readings.
- Measure The Horizontal Visible Iris Diameter (HVID). The HVID is one of the most important factors when choosing the scleral lens diameter.
- Determine the corneal profile
- Prolate vs Oblate
- Consider palpebral fissure
- Follow the manufacture fitting guide
- Evaluate Apical clearance
- Instill fluorescein in the bowl of the lens before insertion
- Evaluate with optic section (while Light)
- Estimate lens thickness to tear thickness ratio
- Document Lens Center Thickness
- Let the lens settle and Reevaluate in 30 minutes
- Measure Apical Clearance
- Evaluate Limbal clearance
- Sweep limbus to limbus using optic section (white light) noting tear reservoir thickness.
- Make sure you have sufficient Apical Clearance.
- Scleral landing zone
- Evaluate for an ideal edge lift
- Address any impingements or compressions
- Perform a spherical over-refraction first
- Next perform a sphero-cylindrical over-refraction to check for any additional vision improvement
- Order the spherical over-refraction
Prepare your patient for lens dispensing and be sure to use the proper lens care system then schedule the follow-up care.
A big “THANK YOU” to Dr. Elise Kramer and Dr. Roxanne Coan. The clinical pearls they shared with us was priceless.
Scleral Contact Lens Basics Workshop
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