Spectrum of Scleral Lens Fit and Patient Compliance: A Single Center Retrospective Study

Abstract

Objectives: To discuss the results of scleral contact lens fit in patients with difficult corneal and ocular surface pathologies. Materials and Methods: This single-center, retrospective case-series included 49 eyes of 34 patients who underwent scleral lens fitting for visual acuity improvement from February 2018 to 2023. All patients underwent Orbscan/Pentacam corneal topography before a complete ophthalmological exam. The first trial lens was chosen according to manufacturer guidelines and topographic parameters. Best corrected Snellen visual acuity was assessed with spectacles before fit and over-refraction after fit and converted to logarithm of the minimum angle of resolution (logMAR). The vault was evaluated both at the slit-lamp and with anterior segment optic coherence tomography when possible. Results: Twenty-one patients (61.8%) were male and the mean age was 37.4±14.8 years (range: 12-71). Twenty-three eyes (46.9%) had keratoconus, 11 eyes (22.4%) had refractive error after penetrating keratoplasty, 7 eyes (14.3%) had irregular astigmatism due to corneal scar, 4 eyes (8.2%) had advanced stage Steven-Johnson syndrome, 2 eyes (4.1%) had corneal perforation repair, and 2 eyes (4.1%) had severe dry eye. The appropriate lens was determined after 3.7±1.9 trials (range: 1-8 trials.) Although five patients refused scleral contact lenses due to cost, lenses were successfully fitted and used in 39 eyes of 29 patients. The mean daily wear time was 9.3±4.5 hours (range: 2-16) and mean follow-up was 52±49 months (range: 12-180). Mean uncorrected logMAR visual acuity and mean spectacle-corrected logMAR visual acuity was 1.09±0.47 and 0.67±0.50, which improved significantly to 0.13±0.20 after scleral contact lens fitting. Conclusion: Scleral lens fit is a time-consuming practice for the ophthalmologist and an intimidating task for the patient. However, in addition to their good optical results, they provide very good comfort and stability. Although the large diameter may seem like the major disadvantage during scleral lens trial, the cost becomes more of an issue in developing countries.

Keywords

• irregular astigmatism
• keratoconus
• keratoplasty
• scleral contact lens