In early 2020, X-Cel Specialty Contacts expanded the design and parameter availability of its Atlantis scleral lens. The expansion allows practitioners to independently adjust the central sag (up to 200 microns in 50-micron steps) and adds quadrant-specific landing and vault zone options.

X-Cel also designed two new fitting sets: a 15.5mm-diameter 12-lens set for existing Atlantis set holders, and a 24-lens set for new users containing 14.5mm, 15.5mm, and 16.5mm diameters. A new fitting guide that applies to all Atlantis scleral designs accompanied the Atlantis expansion.

Parameters of the Atlantis scleral lens include base curves of 6.50mm to 9.12mm; diameters of 14.0mm to 17.5mm (0.5mm steps); sphere powers of +20.00D to –20.00D (0.25D steps); limbal vault zone: up to 100 microns decrease, up to 200 microns increase, quadrant-specific control; scleral zone: 1 flat to 8 flat, 1 steep to 8 steep (25-micron steps); toric scleral zone: bi-meridian and quadrant-specific control; cylinder powers of –0.75D to –5.00D (0.25D steps) in axes of 0º to 180º; multifocal distance zones of 3.6mm, 4.0mm, and 4.4mm; and add powers of +0.75D to +4.00D. It is manufactured in Optimum Extra, Optimum Extreme, and Optimum Infinite (all Contamac); Boston XO and Boston XO2 (Bausch + Lomb); and Paragon HDS (Paragon Vision Sciences). All Atlantis scleral lenses are plasma treated free of charge, and Tangible Hydra-PEG (Tangible Science) coating is available.

I recently spoke with two practitioners who are actively prescribing Atlantis scleral lenses in their practices. Here we provide their clinical experiences.

Please tell us about your general experience with X-Cel’s Atlantis scleral lens.

Nicholas McColley, OD, MBA, of Greenfield, IN, says that his experience with the lens has been fantastic, in part because the employees at X-Cel listen to eyecare professionals. “Over the years, I’ve seen the company adapt and change based on provider preferences. For example, they are constantly making their process more user friendly with return policies and consultation,” he says. With regard to the lens itself, Dr. McColley adds that “They’ve consistently expanded parameters and their capabilities to modify different aspects of the lens independently, while expanding the fit sets to make it easier on providers from the first diagnostic lens.”

Susan Dini, OD, of Seattle, shares a similar experience. “The new fitting set is impressive. It provides options for a wide array of sagittal depth needs and accommodates various scleral shapes,” she says. She adds that the fitting set is bitoric and offers the capability for quadrant customization in both the limbal and scleral zones. “You can also correct residual astigmatism on the front lens surface with an over-refraction and, if needed, accommodate presbyopia corrections,” she notes.

Dr. McColley adds that Atlantis’ varied diameters, quadrant-specific options, and ability to move the midperipheral zone “in” or “out” allow practitioners to fit a much broader range of candidates and different corneas, whether the lens is for a cornea with pathology or for dry eye. “They also have a great patient starter kit available,” he says.

Who are the best candidates for this product and why?

Both Dr. Dini and Dr. McColley indicated that the Atlantis scleral is a lens that comes to mind for a broad range of patients. “Any patients who have an irregular cornea and compromised vision such as in keratoconus, post-surgical ectasia, and corneal transplantation are good candidates. Patients needing additional ocular surface protection due to underlying medical conditions such as chronic dry eye, Sjögren’s, graft-versus-host disease, and Stevens-Johnson also are great candidates,” says Dr. Dini. “In addition, these lenses can be beneficial for high refractive errors, athletes requiring precise vision, and presbyopes who have high near demands,” she adds.

Because the lens is so customizable, Dr. McColley considers the Atlantis scleral for both prolate and oblate corneas and for any patients who have corneal pathology and require lenses for medical necessity. That said, his fastest-growing segment is made up of dry eye patients who are willing to invest in the lenses in combination with other dry eye therapies to feel relief even if they don’t qualify for medically necessary benefits. He says, “They tend to also be my happiest patients, and they refer more dry eye patients to our clinic. Many of my dry eye patients who previously wore other scleral lenses are much happier in the Atlantis lenses because they feel less obtrusive on the eye compared to some thicker lenses.”

Tell us about the prescribing process and what has worked best for you.

Dr. McColley says, “My fit set has three diameters, with multiple sag values and two sets of scleral zone toricity for each sag value. They all have easily identifiable markers to allow for very specific initial lens determination. The fit guide points you in the right direction for the initial diagnostic lens, making it easy to start. Once the lenses are on the eye, the toricity helps to reduce the number of lenses needed to reach a final fit, because you can determine lens rotation for toric optics and trouble areas in the landing zone,” he says. He also explains that the lenses are dotted on quadrants 2, 3, and 4 to make is easy for practitioners to determine whether quadrant-specific lenses are needed.

Dr. Dini notes that the fitting process has been streamlined to reduce chair time, and the lenses have a toric scleral zone to better align with more scleras. “When assessing the lens, the center zone or clearance is observed first. The ideal lens clearance is 300 microns after 30-minute settling. You next assess the limbal zone to confirm that there’s enough vault over that region, then assess the scleral zone to confirm that the lens is evenly landing on the sclera. The limbal and scleral zone can be modified either bitorically or quadrant specifically. The beauty in customizing the lenses is that the central zone, sag, and the limbal and scleral zones can all be modified independently, plus notching (peripheral modification for conditions such as pterygia) is available,” she says.

Dr. McColley recommends thinking about Atlantis scleral lenses from a practice management standpoint. “The fitting set makes it easy to reduce the number of lenses that a patient must try, which reduces both chair time and frustration for patients. Many are new to scleral lenses, and even if you explain that multiple lenses may need to be ordered, they can become discouraged if the first or second is not correct,” he says. Dr. McColley adds, “The Atlantis lens hits my two biggest markers for a successful product: 1) It is patient friendly/makes their life easier, and 2) It makes financial sense.”

How has Atlantis scleral helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Dr. Dini shares that “These lenses have been particularly helpful when fitting trauma eyes; many penetrating eye injuries result in scarring, contour changes of the cornea and sclera, and special refractive needs. Atlantis is easy to customize and accommodates peripheral corneal scarring/elevation as well as scleral variations. It addresses high refractive needs along with residual astigmatism and multifocal needs.”

Dr. McColley notes that he has a base of older patients who have dry eye issues but also tend to be visually demanding. He inherited one 62-year-old female who was wearing another design and was struggling with fogging throughout the day, unsatisfactory distance and near vision (monovision optics), and uncomfortable impingement nasally due to a moderate pinguecula. “From the initial diagnostic lenses, the patient was thrilled with the comfort, even though the fit was still not ideal. The first set of ordered lenses had multifocal optics that provided better vision compared to her previous lenses, felt more comfortable, and did not fog. She was thrilled with the vision, although she admitted to a slight blur at distance. Because of the flexibility of the multifocal design (three different optic zones, all center-distance), we increased the central zone in her dominant eye and added a notch to avoid nasal impingement. She couldn’t believe that it could get any better than it already was; she has become one of my most loyal patients and refers everyone she can to me,” he says. CLS