Millions of patients around the world wear contact lenses to correct their vision.1In fact, research suggests that contact lenses provide patients with benefits such as better perceived cosmetic appearance, better social acceptance, and a better ability to play sports compared to glasses.2-4While most contact lens wearers use soft contact lenses for cosmetic reasons, some patients wear specialty hard contact lenses because they are the only way that they can achieve functional vision without undergoing surgery to correct a visually debilitating eye disease like keratoconus (a degenerative disease that results in an irregularly shaped cornea).5In other cases, patients who suffer from moderate to severe dry eyes wear specialty contact lenses because they have the ability to make their eyes comfortable enough to effectively function.6While there is more than one type of specialty contact lens that can help patients with these conditions, scleral lenses have emerged over the past few years as the contact lens treatment of choice for these difficult-to-treat patients.7
Scleral lenses are large diameter (typically 15 to 18 mm wide) contact lenses that completely vault the cornea and rest of the sclera.8 While this lens modality was actually the first style of contact lens, it has only recently gained popularity because we now have materials technology that makes scleral lenses safe enough for daily wear.9When applying scleral lenses, the wearer fills them with non-preserved saline, which when on the eye provides a layer of solution between the cornea and lens. This solution hydrates the eye and provides comfort to patients who have dry eyes.10This design also creates a smooth refractive surface, which allows patients who have irregularly shaped corneas the ability to see clearly.10In fact, some patients who use these lenses improve their vision by more than 10 lines on the eye chart compared to their glasses.5
Scleral lenses have historically only been fit by leaders within the eye care field at tertiary clinics.7However, with improvements in scleral lens technology, more companies producing these lenses, and better education available, more and more practitioners are using this technology.3In fact, Nau et al. found that more than half of scleral lens fitters work in the private practice setting.9This same study found that scleral lens fitters tended to be educated more recently. Scleral lens technological improvements have also allowed these lenses to be useful for other hard-to-fit patients who have conditions such as high myopia, high astigmatism, or presbyopia, which has further bolstered this modality’s popularity.7
Scleral Lens Safety
While no well-controlled epidemiological studies have been performed to understand scleral lens safety, emergent scleral lens-related complications are thought to be rare. Schornack et al. has reported that scleral lens wearers have an incidence of corneal edema, corneal infiltrates, and microbial keratitis of 0.45%, 0.17%, and 0.08%, respectively.11Nevertheless, scleral lenses are prone to less serious issues such as poor lens wetting and midday fogging (buildup of particulate matter within the lens tear reservoir), which can result in variable and decreased vision throughout the day.8Pucker et al. have found that practitioners alleviate these issues by educating patients to simply remove, clean, and reapply their lens.5
Recent research from Bickle et al. suggests that new scleral lens wearers have no (72.7%) or only some (27.3%) hesitation to trying scleral lenses for the first time.12This same study found that 91.2% of patients were able to learn how to use scleral lenses within two training visits.12Likewise, this study found that 68% of patients indicated that they found it easy to learn how to use scleral lenses, 68.2% of patients found it easy to apply their lenses after one week, and 77.3% of patients found it easy to remove their lenses after one week.12
Scleral lenses overall have the ability to change lives by offering patients clearer and more comfortable vision compared to glasses, and they have been shown to allow patients to postpone or avoid the need for surgical interventions.10Scleral lens technology is also quickly evolving, so this technology will likely continue to gain popularity and be a useful vision correction method for more and more patients.9
Dr. Andrew D. Pucker is an assistant professor at the UAB School of Optometry, which operates UAB Eye Care. The Cornea and Contact Lens Service is now accepting patients. Learn more by calling 205-975-2020.
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