Dry Eye Dx and Tx

Changing Lives with New Scleral Lens Technology

BY KATHERINE M. MASTROTA, MS, OD, FAAO

The balance of the ocular surface can be compromised by a multitude of pathologies or trauma that impact ocular comfort and reduce vision. Dedicated contact lens practitioners have recognized that scleral contact lenses can, in effect, resurface the eye, restoring clarity and improving comfort (visit the Scleral Lens Education Society for additional information: www.sclerallens.org). There are many excellent scleral lenses from which to choose; the expertise of each clinician guides lens modifications for a comfortable, well-positioned lens that stabilizes the ocular surface.

A new technology in scleral lens design is the EyePrintPro. Developed by Christine Sindt, OD, FAAO, and Keith Parker, NCLEC, the EyePrintPro prosthetic is an individualized, customizable prosthetic lens for difficult-to-fit and highly irregular corneas. The EyePrintPro lens involves making an impression of the ocular surface using a proprietary polymer. The impression is scanned in 3D, and a lens is designed with advanced software. The result is a prosthesis contoured to fit the patient’s entire ocular surface. Advanced optics, such as torics, prisms, and multifocals with decentered optical axes, are available in this design because of its rotational stability.

The EyePrintPro lens is indicated for multiple pathologies including keratoconus, irregular astigmatism, ocular surface disease (dry eye), trauma, extreme cases of deformed eyes, pellucid marginal degeneration, chemical burns, post-surgical corneas (including corneal transplants and post-LASIK ectasia), pingueculae, pterygia, and stem cell failure.

Case Example

This patient’s eye was hit with an exploding firecracker in July 2012. He had subsequent extensive trauma-related stem cell loss and underwent a buccal mucosa graft a year later. Currently, he has extreme elevation differences—greater than 1mm—across his ocular surface. He has extensive scarring and irregularity. His uncorrected vision is less than 20/400. With a GP lens held in place, he can see 20/70, but no GP lens stays on the eye, and scleral GPs don’t position because of significant elevation differences. The contoured fit of the EyePrintPro (Figure 1) allows this patient to see 20/40.

Figure 1. The EyePrintPro digital profiling system generates scleral GPs matched to the corneo-scleral contour of complicated surfaces.
COURTESY OF CHRISTINE SINDT, OD, FAAO

The patient was also bothered by discomfort, most likely related to poor wetting of his corneal surface secondary to its irregularity. With this scleral lens, his ocular comfort also improved. CLS

Dr. Mastrota is secretary of the Anterior Segment Section of the American Academy of Optometry. She is a consultant or advisor to Allergan, B+L, BioTissue, Nicox, and OcuSoft and is a stock shareholder of TearLab Corporation. Contact her at katherinemastrota@msn.com.