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Muriel Schornack, Cherie Nau, Jeff Pyle, Sanjay Patel; Visual Correction for Irregular Corneas with Scleral Lenses. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5465. doi: https://doi.org/.
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Scleral rigid gas permeable lenses can optically neutralize corneal surface irregularity in patients with primary corneal ectasia, corneal scarring, or post-surgical irregularity. In this study, we reviewed the outcomes of commercially available Jupiter™ scleral lenses for corneal irregularity.
In a retrospective study, we identified 137 eyes of 96 patients that were fit with Jupiter™ scleral lenses (Visionary Optics, Front Royal, VA, and Essilor Contact Lens, Inc., Dallas, TX) between June 2006 and November 2011 for primary or secondary corneal irregularity. Specific indications for which scleral lenses were prescribed, prior modes of optical correction, topographic characteristics, visual acuity prior to and after lens fitting, details of the fitting process, and clinical outcomes were recorded. Visual acuity with habitual correction before scleral lens wear was compared to that with scleral lenses by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject.
Mean age of patients was 46 years (range 11-83 years). Scleral lenses were prescribed for visual rehabilitation in patients with keratoconus/pellucid marginal corneal degeneration (68 eyes), penetrating keratoplasty (27 eyes), post-refractive surgery (27 eyes), scarring after keratitis (7 eyes), Terrien marginal degeneration (3 eyes), ocular trauma (2 eyes), monocular diplopia (2 eyes), and congenital corneal defect (1 eye). Most patients had attempted to wear corneal rigid gas permeable lenses, hybrid lenses, or piggyback lens systems prior to commencing scleral lens wear. The fitting process required an average of 3 visits (range 2-7), and an average of 1.6 lenses (range 1-7) were ordered per eye. All patients wore lenses successfully at the conclusion of the fitting process. Median simulated steep K was 49.00 D (range 35.25-69.00 D), median flat K was 43.50 D (range 31.87-54.87 D), and median reference sphere was 45.86 D (range 38.6-57.5 D). Median visual acuity improved from 0.39 log MAR (Snellen equivalent, 20/49) with habitual correction to 0.10 log MAR (Snellen equivalent, 20/25) after scleral lens wear (p<0.001).
Commercially available scleral lenses can effectively provide optical correction for both primary and secondary corneal irregularity, even when other types of lenses have failed. Irregular corneas can be fit with scleral lenses with relatively few office visits.
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