The past several years have been tremendous in the contact lens field. This is especially true in the specialty contact lens arena, particularly with scleral contact lenses. We have seen many new lens designs and materials come forward to help us provide the very best care to our patients. These designs and materials sometimes present unique challenges relative to lens care and subsequent patient aftercare.

For instance, although not well studied, it is thought that a fair number of scleral lens wearers experience “midday fogging,” in which vision becomes hazy or foggy after a few hours of scleral lens wear. To the best of my knowledge, no laboratory tests have confirmed the composition of the fog, and no factors seem to be predictive of its onset. While not associated with any other clinical sequelae, attempts should be made—with lens materials, designs, or care and aftercare regimens—to help reduce or, better yet, prevent continued fogging. Further research is needed to determine the source and mechanism of this scleral lens complication so that optimized prevention strategies can be implemented.

Another interesting consideration is the role of the care system in the success of specialty lens wearers. For instance, market research from several years ago indicated that practitioners were primarily recommending GP-based cleaners and disinfectants for the care of scleral lenses (http://archive.constantcontact.com/fs030/1101462388342/archive/1103899240059.html ; www.cltoday.com/issues/CLToday_042813.htm ). However, market research reported in 2017 shows a different trend in which practitioners are primarily recommending hydrogen peroxide-based systems for their scleral lens wearers (Harthan et al, 2017; Contact Lenses Today, 2017). Why the change?

Specialty lenses afford several opportunities to help lots of patients, many of whom have very diseased eyes. However, we still need help understanding some clinical questions to better serve our patients and practices.

For references, please visit www.clspectrum.com/references and click on document #259.