Abstract
Purpose: :
Rigid gas permeable scleral lenses rest entirely upon the sclera and completely vault the cornea and limbus, maintaining a fluid reservoir between the lens and the cornea. These unique fitting characteristics allow the devices to protect the ocular surface. In this study, we report the use of Jupiter scleral lenses in 114 patients with ocular surface disease in an outpatient setting.
Methods: :
Data were collected by a retrospective chart review of patients with ocular surface disease who were fit with Jupiter™ scleral lenses (Visionary Optics, Front Royal, VA, and Essilor Contact Lens, Inc., Dallas, TX) between June 2006 and November 2011. Conditions for which scleral lenses were prescribed, prior intervention, visual acuity prior to and after scleral lens fitting, details of the fitting process, and clinical outcomes were recorded. Visual acuity before and after scleral lens wear was compared by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject.
Results: :
Scleral lenses were prescribed for 114 patients (185 eyes); mean age was 52 years (range, 6-85 years). Lenses were prescribed for the management of chronic graft vs. host disease (23 eyes), exposure keratopathy (19 eyes), neurotrophic keratopathy (17 eyes), Salzmann’s nodular degeneration (9 eyes), limbal stem cell deficiency (8 eyes), Sjögren’s syndrome (6 eyes), post-refractive surgery dry eye (5 eyes), ocular cicatricial pemphigoid (4 eyes), uncomplicated dry eye syndrome (65 eyes) and other ocular surface conditions (29 eyes). Most patients had tried other forms of intervention prior to initiation of scleral lens wear, including lubricant drops, punctal occlusion, topical cyclosporine, topical corticosteroids, oral antibiotics, moisture chamber goggles, and surgical intervention (tarsorrhaphy, conjunctival flap). Completion of the fitting process required an average of 3 visits (range, 2-6), and an average of 1.4 lenses (range, 1-3) were ordered per eye. All patients wore lenses successfully at the conclusion of the fitting process. Median visual acuity improved from 0.22 log MAR (Snellen equivalent, 20/33) with habitual correction to 0.08 log MAR (Snellen equivalent, 20/24) after scleral lens wear (p<0.003, n=183).
Conclusions: :
Commercially available scleral lenses can be effective in the management of a variety of conditions that compromise the ocular surface. Although the primary goal of scleral lens wear in these patients is ocular surface protection, visual acuity also improves with lens wear in the majority. The process of fitting Jupiter scleral lenses is generally completed within relatively few office visits.
Keywords: cornea: tears/tear film/dry eye • contact lens • cornea: clinical science