Retrospective review affirms scleral lenses for keratoconus safe, effective
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Scleral contact lenses for the visual rehabilitation of patients with keratoconus were safe and efficacious, according to a record review published in Optometry and Vision Science.
“Other more contemporary studies have focused on case reports and case series or are limited by small sample sizes in a single lens type,” Daniel Fuller, OD, of the Southern College of Optometry, and colleagues wrote. “Because compromised corneas are more susceptible to adverse events, it is difficult to generalize these results to keratoconus patients and determine the risks associated with scleral wear in this population.”
Fuller and colleagues conducted a retrospective analysis of patients with keratoconus who were examined between 2013 and 2018. They included patients regardless of age, sex, pre-existing morbidity or scleral lens design. Inclusion criteria required successful fitting of scleral contact lenses for at least 1 year. Prior corneal surgery, dystrophy, degeneration and trauma were exclusion criteria.
The final analysis included 157 eyes from 86 patients with keratoconus. Most patients were female (n = 48), and the mean initial age of scleral fitting was 34.8 ± 11.7 years (range, 14-64 years).
Investigators defined safety as the number of adverse events experienced by patients after the first year of lens finalization. They divided adverse events into those that affected physiology and those that were lens related.
The review identified adverse events in 9.6% of eyes, including hydrops (3.2%), pingueculitis (1.3%) and corneal infiltrative events (1.3%); and lens-related adverse events in 55.4% of eyes, including broken lenses (26.1%), lens intolerance (7.6%) and reservoir fogging (7.0%).
Fuller and colleagues reported a mean logMAR of 0.5 (95% CI, 0.44-0.56) in spectacles improved to a mean logMAR of 0.08 (95% CI, 0.06-0.11) in scleral lenses. They also noted that 14.6% of eyes experienced a loss in best-corrected scleral lens visual acuity due to keratoconus progression.
“Consistent with findings of other groups, our study demonstrates excellent long-term safety and efficacy of scleral lenses in the visual rehabilitation in subjects with keratoconus,” the researchers wrote.
Perspective
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Fuller and Wang’s recent study aimed to increase understanding of the safety and efficacy of scleral lenses in patients who have been diagnosed with keratoconus. While other investigators have included this subgroup in their scleral lens safety studies, this article is one of the first to evaluate scleral lens safety in keratoconus patients exclusively.
This retrospective study of 157 eyes determined several key clinical points that can be applied to everyday care. While keratoconus patients have compromised corneas, they likely have a similar risk for developing inflammatory and infective adverse events as healthy patients who are wearing soft contact lenses. The most common physiological adverse event that occurs in keratoconus patients who wear scleral lenses is corneal hydrops. The most common lens-related adverse event in keratoconus patients who wear scleral lenses is having a damaged or lost lens. Most (54%) adverse events were successfully treated with a scleral lens refit.
Scleral lenses can dramatically increase visual acuity of patients who have keratoconus. These data overall suggest that scleral lenses are likely safe and effective in patients with keratoconus.
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Fuller D, et al. Optom Vis Sci. 2020;doi:10.1097/OPX.0000000000001578
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