Pediatric and Teen CL Care

Mini-Scleral Lenses Are an Excellent Choice for Young Kids

BY CHRISTINE W. SINDT, OD, FAAO

When most practitioners think of scleral lenses, they think “problem eyes.” Yet scleral lenses, especially mini-sclerals, are making their way into the mainstream for people who want the excellent vision of GP lenses with the comfort of soft lenses. Mini-scleral lenses, in particular, are an excellent choice for young patients because they have the added benefit of ease of handling for little fingers.

A Case for Mini-Sclerals Rather Than Soft Torics

Let’s look at the case of Little Billy, a delightful 7-year-old boy who is on the autism spectrum. He is a moderate hyperope who has a fair amount of astigmatism. His prescription is approximately +7.50 -3.50 x 180 in both eyes.

Billy has been struggling in school and self-admits to having some coordination issues. His parents wonder whether his vision, and in particular his glasses, are causing some of his delays. Looking at his glasses, which are sitting crooked and smudged on his face, with his giant, magnified eyes staring out at me, I can’t help but think that his mom and dad may be on to something.

Billy’s options are, of course, soft toric contact lenses or GP contact lenses. Within the GP realm, he has further choices of a bitoric, small-diameter GP design or a larger-diameter (mini-scleral or scleral) spherical lens. It has been my experience that young hyperopic astigmats see better out of GP contact lenses. With this in mind, I advised Little Billy’s parents of his options:

1. A soft toric lens has excellent application comfort, but may not be as stable or provide the quality of vision that he would get with a GP lens design. I am concerned that, because of Billy’s autism (his reaction to touch), application may be difficult and a soft contact lens will never get onto his eye.

2. A GP lens will be easier to apply and remove (Billy doesn’t even have to voluntarily open his eyes); in addition, they last longer, are easier to clean, and will provide crisper, more stable optics.

While both GP options—the small-diameter bitoric design and the scleral design—will have these GP benefits, the mini-scleral will stay in place better, be more comfortable, and be easier for the parents (or Billy) to apply and remove. Mini-scleral lenses do not need the bowl filled with saline as their larger scleral cousins do, so patients do not need to apply them in a face-down position.

Another advantage of a mini-scleral lens design is that, in most cases, a spherical lens can be ordered, making the lens design and optics much simpler.

Based on these options, we went ahead with mini-scleral lenses for Little Billy.

A Great Choice for Children

Little Billy loves his contact lenses. He knows that he sees better with his lenses and now asks for them. His mom and dad are pros at application and removal and have their “system” worked out with their adorable, yet sometimes challenging, autistic child.

As Billy hands me a Thank You card (which he wrote himself!) and I see the relief and gratitude in his parents’ eyes…I know that mini-scleral contact lenses are an excellent choice for young children. CLS

Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is the past chair of the AOA Cornea and Contact Lens Council. She is a consultant or advisor to Alcon Vision Care and Vistakon and has received research funds from Alcon. You can reach her at christine-sindt@uiowa.edu.