Abstract
Purpose :
To describe utilization of diagnostic, image-guided, and impression-based fitting paradigms by eye care providers who prescribe scleral lenses (SLs) for patients with keratoconus.
Methods :
An electronic survey was distributed to eyecare providers who fit SLs. Providers estimated the total number of patients wearing SLs in their practiced and the percentage of patients with keratoconus using different lens modalities. Access and experience with diagnostic, image-guided and impression-based technologies was queried and ANOVA was used for comparisons of 3 fitting methods for each variable (time, number of lenses, number of visits).
Results :
420 providers who prescribe SLs for keratoconus reported mean [SD] 350 [820] patients fit with SLs, range 1-9000 using an estimated 59% SL, 24% corneal, 7% soft, 6% hybrid and 2% piggyback systems. 42%(176) of participants have access to imaging for profilometry, 17%(73) have access to impression-based technology; 10% (43) have both. They estimated 90% [22%] of SL fits utilized diagnostic lenses, 9% [21%] image-guided technology, and 2% [5%] were impression-based.
No statistical difference in total time required for initial lens order was found based on fitting method. Estimated time for initial evaluation was 46.3 [69.5]] minutes for diagnostic, 38.6 [35.5] minutes for image-based, and 38.3 [25.6] minutes for impression-based. Initial images were sufficient to allow for fabrication of an initial lens 69.8% [30.5%] of the time and initial impressions were sufficient 80.2% [26.3%] of the time.
A statistical difference (P=0.001) in the number of lenses ordered and the number of office visits required (P=0.006) was found when comparing diagnostic to impression based lens design but not when comparing diagnostic to image-guided or image-guided to impression based fitting. Mean total number of lenses ordered for patients fit with diagnostic lenses, image, or impression-based technology was 2.4 [1.3], 2.2 [0.8], and 1.9 [0.8] and mean number of visits required for each group was 4.0 [1.7], 3.7 [1.3] and 3.4 [1.2] respectively.
Conclusions :
Most SLs are fit using diagnostic lenses, even when practitioners have access to imaging-guided or impression-based technology. Approximately 30% of image-based fits and 20% of impression-based fits require patients to return a second time for additional imaging or impressions before lenses can be fabricated.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.