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Ellen S Shorter, Jennifer Harthan, Cherie B Nau, Amy Nau, Joseph T Barr, Muriel Schornack; The Role of Scleral Lenses in the treatment of Corneal irregularity and Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1475.
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© 2017 Association for Research in Vision and Ophthalmology.
Although scleral lenses are being prescribed for a variety of indications, there is no established standard of care for their use. The purpose of this study is to describe the role of scleral lenses in the treatment of corneal irregularity and ocular surface disease.
A 19-item survey about scleral lens prescription and management practices was administered electronically by the Mayo Clinic Survey Research Center between 1/12/15 and 3/31/15. Members of professional optometric and ophthalmologic organizations were invited to participate via e-mail. A link to the survey was also distributed by an international contact lens-related electronic newsletter. All responses were anonymous and identifying information was removed prior to data analysis. Participants who had fit 5 or more patients with scleral lenses were asked to describe the type of optical correction they prescribe for corneal irregularity and to rank therapeutic interventions they prescribe for the management of ocular surface disease.
A total of 989 practitioners responded to the survey, of whom 723 reported fitting 5 or more patients with scleral lenses. Practitioners (n=629) responded that the initial optical correction they consider for corneal irregularity is a corneal gas permeable lens (44%), a scleral lens (34.5%), a standard hydrogel or silicone hydrogel lens (12.7%), a hybrid lens (4.9%), a custom hydrogel or silicone hydrogel lenses (3.3%) followed by a piggyback lens systems (0.5%). The majority of practitioners (n= 612, 84%) report prescribing lubricant eye drops for the initial management of ocular surface disease. The second recommendations were typically topical steroids (25.8%), topical cyclosporine (21.9%) and punctal occlusion (19.8%) followed by scleral lenses, systemic antibiotics and moisture chamber goggles. The late interventions included topical antibiotics, autologous serum tears, amniotic membrane grafts and lastly tarsorrhaphy.
Corneal gas permeable lenses are the most commonly prescribed optical correction for corneal irregularity; however, scleral lenses are being prescribed as the initial correction by more than a third of prescribers in this cohort. Scleral lenses are also being prescribed for ocular surface disease after topical lubricants, topical steroids, topical cyclosporine and punctal occlusion.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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