Dry eye negatively affects patients who wear contact lenses and can lead to eventual dropout (Pucker et al, 2019; Richdale et al, 2007). Scleral lenses have an antithetical ability to improve anterior ocular health and to reduce symptoms in patients who have severe dry eye or ocular surface disease. Oftentimes, these patients have a primary systemic disease with secondary dry eye. For these patients, scleral lenses offer protection and a fluid reservoir that continuously bathes the corneal surface.

A contact lens must have an even and continuous pre-lens tear film for patients to have comfortable lens wear and best-corrected vision. Despite advances in materials and surface coatings, this can be especially challenging to achieve for patients who have dry eye but are otherwise successful with scleral lens wear.

Case Example

A 51-year-old female patient reported for a scleral lens evaluation. Her history included Sjögren’s, keratoconus, and attempted laser-assisted in-situ keratomileusis (LASIK) surgery OD, with a flap but no treatment. For dry eye management, she was previously treated with cyclosporine, lifitegrast, and punctal plugs.

She came in wearing frequent replacement soft lenses but complained of poor vision. The patient had previously failed in hybrid lenses due to discomfort. Her current spectacles were OD –0.25 –3.75 x 006, 20/40 and OS –1.00 –4.00 x 159, 20/20. She was fit with 16.5mm free-form customized scleral lenses manufactured in Optimum Infinite (Contamac) material with Hydra-PEG (Tangible Science) coating. I proactively added the coating to improve her chances of successful wetting based upon her dry eye diagnosis. The lenses provided 20/20 vision in both eyes, and she was instructed to clean/disinfect her lenses with Clear Care (Alcon).

At her first follow-up visit, she reported that the right lens wasn’t always wetting and that she had some symptomatic midday fogging of her left lens, which fit slightly loose. We reordered and dispensed a left lens with a steeper landing zone.

At her nine-month appointment, the midday fogging had resolved, but neither lens was wetting well (Figure 1) and she had significant deposits on the left lens (Figure 2). Poor-wetting lenses can increase lens deposition. We had a new set of duplicate lenses shipped to her and asked her to return in six months.

Conclusion

Although this patient's situation improved with scleral lens wear, the non-wetting lenses and deposits create issues with vision and comfort. Also, potentially needing to replace her lenses every nine months is less than ideal. Despite the specialty lens industry having made significant strides with materials and coatings, some patients continue to struggle. Hopefully, booster solutions for lens conditioning will allow for longer symptom-free relief. CLS

For references, please visit www.clspectrum.com/references and click on document #296.