Managing scleral lens wear requires monitoring ocular surface disease
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A presenter at this year’s SECO meeting provided an overview of ocular complications and concerns related to fitting and wear of scleral lenses, including increased cases of ocular surface disease such as dry eye.
“Scleral lenses have really changed how we practice,” Jason Jedlicka, OD, FAAO, FSLS, FCLSA, said during his presentation. “Nowadays, contact lens intolerance is not really a concern anymore. Everyone should be able to tolerate contact lenses.”
Jedlicka said that while “we might not know everything about scleral lenses,” the key is to be astute in patient management and continue to monitor a patient’s vision and satisfaction.
“Part of the problem is also that scleral lens technology is changing so quickly, so the things that may have been a problem 5 or 10 years ago, we have figured out,” he said. “But now we face new challenges. There is a lag between discovering issues and figuring them out. It takes some time and experience.”
Complications that occur in the presence of an otherwise acceptable looking fit can include:
- Anterior lens surface non-wetting;
- Conjunctival hypertrophy or prolapse;
- Corneal edema or neovascularization;
- Peripheral corneal bullae;
- Posterior lens fluid reservoir fogging; and
- IOP elevation or wound gaping from a suctioned fit.
Jedlicka noted that while scleral lenses treat corneal symptoms and disease, the lens can potentially lead to increased visual problems, especially in the case of dry eye disease.
“When we put a patient in scleral lenses for ocular surface disease, I like to tell the patient that I’m managing their ocular surface disease with the lens, but now we have to deal with their lens surface disease, which is just as important,” he said. “As wonderful and life-changing as a scleral lens can be for a patient with dry eyes, you’re making their dry eye disease worse for the lens surface than it ever was for their cornea. Keep in mind that with scleral lenses, there is still a lot of management that needs to happen.”
His recommendations for such management include treating the ocular surface issues with proper lid hygiene, omega-3s and medications as needed, along with stabilizing the tear film through standard dry eye management.
Jedlicka also recommended to ensure that lenses that are shipped dry are cleaned and soaked prior to dispensing, as some scleral lens issues arise at the dispensing visit.
“Sometimes patients need that conditioning step and should be made aware that they must rinse that conditioner off at least somewhat before they place the lens,” Jedlicka said. “We want to make sure patients are aware of all the proper steps for caring for their lenses.”
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Jedlicka J. Scleral lens complications and controversies. Presented at: SECO; Atlanta, Georgia; April 28-May 2, 2021.
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