Study suggests no significant impact of scleral lens wear on IOP in healthy eyes
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An investigation involving healthy adult eyes naïve to scleral contact lens wear identified a minimal effect on IOP homeostasis and optic nerve morphology after wearing lenses.
“With evidence of adverse events and considering the diseased eyes for which they are indicated, it is imperative to understand both the positive and negative ocular health impacts of scleral lenses,” Maria Walker, OD, MS, FAAO, of the University of Houston College of Optometry, and colleagues wrote in Optometry and Vision Science.
Walker and colleagues conducted an experiment of 26 “healthy scleral lens neophytes.” Potential participants were excluded if they had a history of glaucoma, hypertension or ocular surgery and if their IOP measured greater than 20 mm Hg in either eye upon enrollment.
The final analysis included 52 eyes from 26 patients with a mean central corneal thickness of 540 m before lens wear. Participants were between 23 and 33 years old, with the majority (81%) being female.
Participants wore scleral lenses for 6 hours in one randomly selected eye, and the other eye was the control. At the 2- and 6-hour marks, global minimum rim width, IOP, central corneal thickness, anterior chamber depth and fluid reservoir depth were monitored.
The investigation identified minimum rim width thinning in test (8 m) and control eyes (6 m) after 6 hours of lens wear, with minimal difference in thinning. Mean IOP increased in test eyes (P = .002) with no change in control eyes. Investigators reported “no clinically significant changes in central corneal thickness or anterior chamber depth.
“This study suggests that scleral lenses have a relatively small effect on IOP in the normal eye, and that any impacts of pressure fluctuation on the optic nerve are likely not significant for young, healthy eyes,” the researchers wrote. “The long-term effects of scleral lenses on IOP and optic nerve head structure, especially in susceptible eyes, should be investigated.”
Perspective
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Scleral contact lenses are becoming more popular and increasingly used by contact lens practitioners. The lens design can be a concern as it impinges on the conjunctiva near the limbus. This article addresses an important concern about affecting IOP and optic nerve head morphology. The study reveals that there was an increase of 2 mm Hg in IOP after 6 hours of contact lens wear. It may not seem alarming for healthy eyes but can be concerning for clinicians for their patients who may be glaucoma suspects, have higher range of normal IOP or have other eye health conditions.
This study has addressed changes in IOP after a one-time 6 hours of wear. It would have been helpful if we knew the long-term impact of scleral lens wear. It would also be helpful if IOP were checked the following morning to see the baseline IOP before inserting the lenses and its correlation to the previous morning reading. If the IOP the following morning was the same as the previous day, it will be encouraging that the IOP increase due to scleral lens wear was temporary. However, this will have to be repeated several times to reach that conclusion.
We need more long-term wear research to rule out the impact of these contact lenses on IOP.
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Walker MK, et al. Optom Vis Sci. 2020;doi:10.1097/OPX.0000000000001567
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