Survey finds scleral lenses preferred in corneal irregularity treatment
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Key takeaways:
- 42% of providers named scleral lenses as their top treatment choice in patients with corneal irregularity.
- Scleral lenses were ranked a top choice by less than 1% of providers to treat ocular surface disease.
Eye care providers consider scleral lenses to be a first-choice treatment for patients with corneal irregularity, although the lenses were not favored for ocular surface disease, according to a study published in Eye & Contact Lenses.
“The purpose of the current study was to describe current therapeutic prescribing trends for management of patients with irregular corneal astigmatism and ocular surface disease among practitioners who prescribe [scleral lenses],” Ellen Shorter, OD, of the department of ophthalmology and visual sciences at University of Illinois at Chicago, and colleagues wrote.
The researchers distributed electronic surveys to eye care providers between Nov. 8, 2019, and March 31, 2020, to assess scleral lens (SL) treatment preferences. There were 778 practitioners who responded, including 631 who ranked four or more therapeutic options for corneal irregularity and 567 who ranked seven or more for ocular surface disease.
Among the 631 participants ranking corneal irregularity treatment, 42% named SLs as their first choice. This was followed by spectacles (26%) and gas-permeable lenses (20%). Also, 74% of participants ranked SLs as their first, second or third treatment choice, which “suggests a preference for SLs,” according to the researchers.
Unlike corneal irregularity treatment, participants ranking treatment for ocular surface disease did not show a preference for SLs. Among the 567 respondents, less than 1% ranked SLs as an initial treatment. Further, 45% ranked SLs as the sixth, seventh or eighth preferred option. The first-choice treatment for ocular surface disease was over-the-counter lubricant drops, which was selected by 63% of participants.
Shorter and colleagues said the study findings were limited by survey research constraints. Additionally, the researchers reported possible bias by including only practitioners showing interest in SLs.
“Future evaluation of trends in SL use may be affected by introduction of new therapeutic options and lens designs, and increasing knowledge of the risks and benefits of SL wear,” Shorter and colleagues wrote.
Perspective
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Scleral lenses being ranked as the first choice for treating corneal irregularities was no surprise. The increase in tomography capabilities and expansion of lens designs support its transition into the lead position over the last 8 years.
It is also no surprise that SL fitting ranks near the bottom of the list as an ocular surface disease treatment. Comparing the efficacy and ease of use of our go-to topical treatments, gland expression and punctal occlusion to the skill, expense and chair time involved in fitting SLs, it may be difficult for sclerals to climb that ladder until further improvements in technology ease the process. Because this survey was only distributed to SL fitters, and in-office procedures such as intense pulsed light, thermal expression and low-level light therapy were omitted, their ranking is artificially elevated. Perhaps evolving technology can increase the popularity of fitting SLs. However, the assumption is that efficacy will simultaneously improve in the available topical and in-office treatments, making them both an easier first choice and another means to reducing the discomfort that might lead to a scleral lens fit.
While this data simply validates our clinical choices instead of changing our medical decision-making, I found it valuable to know how the first-line treatment choices of U.S. physicians compare to non-U.S. physicians.
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