Clinical Scorecard: The first steps in scleral lens prescribing
At a Glance
| Category | Detail |
|---|---|
| Condition | Advanced keratoconus and ocular surface diseases such as dry eye disease |
| Key Mechanisms | Scleral lenses restore vision and ocular comfort by vaulting the cornea and landing on the sclera, providing customized fit and protection |
| Target Population | Patients with irregular corneas, ocular surface diseases, and those with mild-to-severe symptoms including post-surgical eyes |
| Care Setting | Optometry practices with access to diagnostic technology and trained staff |
Key Highlights
- Scleral lenses improve quality of life by restoring vision and reducing ocular pain in advanced keratoconus and ocular surface diseases.
- Successful fitting requires understanding lens design, ocular surface alignment, and patient education on insertion and removal.
- Utilization of diagnostic tools such as corneal topography and anterior-segment OCT enhances fitting precision and patient outcomes.
Guideline-Based Recommendations
Diagnosis
- Use corneal topography to assess corneal size and shape for lens design decisions.
- Employ anterior-segment OCT to evaluate central and limbal clearance for precise lens fitting.
- Consider slit lamp photography for documentation and consultation with laboratories.
Management
- Select scleral lens diameter and profile based on individual corneal and scleral anatomy.
- Provide thorough patient education on lens insertion and removal techniques.
- Schedule appointments strategically to allow adequate time for fitting and patient training.
Monitoring & Follow-up
- Regularly assess lens fit and ocular surface health using slit lamp and imaging tools.
- Engage trained staff to assist with patient follow-up and troubleshooting.
- Adjust lens parameters as needed based on patient comfort and ocular findings.
Risks
- Be aware of challenges in fitting patients with deep-set orbits or strong blink reflexes.
- Monitor for potential complications related to improper lens fit or poor patient handling.
Patient & Prescribing Data
Patients with irregular corneas, ocular surface diseases, and post-surgical corneal conditions
Scleral lenses can delay or negate the need for corneal transplants in keratoconus when combined with corneal collagen cross-linking; customizable designs accommodate a wide range of disease severities.
Clinical Best Practices
- Seek hands-on and virtual education opportunities including workshops and manufacturer training.
- Recruit and train empathetic staff interested in specialty lens care to support patient education and fitting.
- Utilize advanced imaging technologies to guide lens design and fitting adjustments.
- Schedule scleral lens fittings during less busy clinic times to reduce provider stress and improve patient experience.
- Engage in ongoing education through specialty lens symposia and professional societies to refine skills and network.
References
- Scleral Lens Prescription and Management Practices: Emerging Consensus
- Update on Indications, Complications, and Outcomes of Scleral Contact Lenses
- Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus
- Scleral Lens Education Society
- Global Specialty Lens Symposium
- International Congress of Scleral Contacts
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
