Scleral lenses effective, ‘safe overall’ for pediatric population
Key takeaways:
- Children with ocular surface disease and irregular cornea/refractive conditions treated with scleral lenses experienced improvement in visual acuity.
- Larger diameters did not prevent successful lens fitting.
Scleral lenses demonstrated safety and efficacy for treating ocular surface disease and irregular cornea/refractive conditions in children, according to an approximately 2-decade long study published in Clinical Optometry.
“The long-term nature of our dataset shows that this lens modality is safe overall for this patient population and seems to indicate that caregivers and patients are motivated to master the application and removal technique,” Karen G. Carrasquillo, OD, PhD, FAAO, FSLS, FBCLA, senior vice president of clinical and professional affairs at BostonSight in Needham, Massachusetts, told Healio.
Although previous studies have investigated the benefits and impact of scleral lenses among adults and children, they were limited by small populations and few long-term data, according to the researchers.
This inspired Carrasquillo and colleagues to perform a single-center retrospective study to analyze scleral lens outcomes in a pediatric population.
The study included 209 eyes (101 girl eyes; 112 left eyes) that were treated with customized fabricated scleral lenses between 1998 and 2019 as part of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment by BostonSight, a nonprofit health care organization dedicated to advancing treatments for diseased and damaged eyes.
Only patients aged 17 years and younger at initial clinical evaluation to determine lens candidacy were included; mean age was 10.6 ± 2.6 years at fitting initiation and 14.7 ± 4 years at last evaluation. Most of the treated patients were from the U.S., specifically the Northeast, and Canada.
The researchers reported that of the total eyes, 147 (70%) were treated for ocular surface disease (OSD) — most of whom had limbal stem cell deficiency or neurotrophic keratitis — and 62 (30%) were treated for irregular cornea or refractive conditions, the majority of which were keratoconic eyes.
At the time of review, scleral lens wear was continued in most (n = 147; 70%) eyes. Mean duration of lens wear, based on chart details or contact with primary eye care providers, was 8.2 ± 4.6 years. Conversely, lens wear status was unknown in 46 eyes (22%), and lens wear was stopped in 16 eyes (8%).
The researchers found that lens wear was discontinued in most of the eyes due to insertion and removal difficulties, and they were from the OSD cohort.
The researchers used 113 eyes for visual acuity statistics, reporting that the mean visual acuity of the population increased from 0.93 ± 0.74 LogMAR at time of consultation to 0.43 ± 0.58 LogMAR after initial scleral lens fitting (P < .05). At final evaluation, mean visual acuity was 0.44 ± 0.6 LogMAR (P < .05).
The visual acuity trends persisted in the OSD and irregular cornea cohorts and by sex; however, older patients tended to have better outcomes after the initial fitting and last evaluation.
Finally, the researchers found that mean initial lens diameter of the full cohort was 17.7 ± 1.2 mm, which increased on average by 1.3 mm (P = .0004) over the study, with a final mean lens diameter of 18.2 ± 1.5 mm.
“With 70% of patients still wearing lenses with a mean duration of wear of 8 years, this finding challenges the notion that smaller diameters are needed to be successful with pediatric scleral lens fitting,” Carrasquillo said.
The researchers noted several limitations to the study, including a lack of standardization in clinic charts, which made it difficult for them to explain the details behind complications.
“Primary care providers as well as other specialists should consider referring patients for pediatric scleral lens fitting to address chronic conditions where other modalities have failed,” Carrasquillo told Healio.
Future studies should include prospective cohorts to allow researchers to better understand and document scleral lens complications in the pediatric population, she added.
For more information:
Karen G. Carrasquillo, OD, PhD, FAAO, FSLS, FBCLA, can be reached at kcarrasquillo@bostonsight.org.
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