Clinical Report: The First Steps in Scleral Lens Prescribing

Overview

Scleral lenses offer significant benefits for patients with advanced keratoconus and ocular surface diseases by improving vision and comfort. This report outlines practical strategies for optometrists to overcome initial challenges in scleral lens fitting and prescribing.

Background

Scleral lenses are specialized contact lenses that vault over the cornea and rest on the sclera, providing improved vision and ocular comfort for patients with irregular corneas and ocular surface diseases. They are particularly beneficial for advanced keratoconus and severe dry eye disease, often delaying or negating the need for corneal transplantation. Despite their benefits, many optometrists hesitate to fit scleral lenses due to concerns about design selection, fit, and patient education. With proper training and resources, these challenges can be effectively managed.

Data Highlights

The SCOPE study identifies irregular corneas, such as keratoconus, as the primary indication for scleral lenses, with ocular surface diseases as the second most common indication. Scleral lenses combined with corneal collagen cross-linking may reduce the need for corneal transplants in keratoconus patients. Technologies like corneal topography and anterior-segment OCT enhance fitting precision by assessing corneal shape and lens clearance.

Key Findings

• Scleral lenses significantly improve quality of life by restoring vision and reducing ocular pain in advanced keratoconus and ocular surface disease patients.
• Initial fitting challenges include lens design selection, ocular surface alignment, and patient education on insertion and removal, which can extend chair time.
• Hands-on training, virtual education, and manufacturer support are valuable resources for developing scleral lens fitting skills.
• Corneal topography and anterior-segment OCT are essential tools for customizing lens parameters and ensuring optimal fit, especially in post-surgical or irregular eyes.
• Strategic scheduling and involving motivated staff members enhance the fitting process and patient experience.
• Advanced education and professional meetings provide ongoing learning and mentorship opportunities for scleral lens practitioners.

Clinical Implications

Optometrists new to scleral lens prescribing should seek comprehensive education and utilize diagnostic technologies to improve fitting accuracy. Strategic scheduling and staff involvement can optimize clinic workflow and patient care. These approaches facilitate broader adoption of scleral lenses, enhancing patient outcomes in complex corneal and ocular surface conditions.

Conclusion

By embracing education, technology, and strategic clinical practices, optometrists can confidently incorporate scleral lens prescribing into their services, ultimately improving vision and comfort for patients with challenging ocular conditions.

References

1. Schornack MM et al. 2023 -- Scleral lens prescription and management practices: Emerging consensus
2. Ruiz-Lozano RE et al. 2021 -- Update on indications, complications, and outcomes of scleral contact lenses
3. Koppen C et al. 2018 -- Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus