Recent research provides evidence that scleral lens use has reduced the need for corneal transplants for the keratoconus population. Koppen et al (2018) looked at a retrospective case series and found that successful long-term scleral lens wear halved the need for keratoplasty for patients who had severe keratoconus. The study results reflect my own clinical experience, and I’ve had similar results for patients who have corneal dystrophy.

Case Examples

Case 1 A 26-year-old male presented with lattice corneal dystrophy, which results in amyloid deposits in the corneal stromal that can lead to decreased visual acuity and epithelial erosion. His primary complaint was decreased visual acuity. He was fit with sclerals that provide visual acuity of OD 20/25 and OS 20/30. Lattice dystrophy is autosomal dominant, and the patient’s mother underwent bilateral penetrating keratoplasty as a result of symptomatic lattice dystrophy. She has recurrent lattice changes and now successfully wears scleral lenses for visual improvement.

Case 2 A 40-year-old male diagnosed with granular-lattice dystrophy (Avellino dystrophy) (Figure 1) had complaints of decreased best-corrected vision, photophobia, and dryness. His father and brother had a history of corneal transplants. He was successfully fit with sclerals (Figure 2) and achieved visual acuity of OD 20/40 and OS 20/20. His scleral lenses also help protect the ocular surface to improve comfort.

Case 3 Corneal dystrophies of the stroma often result in significant visual loss secondary to opacification and development of corneal irregularity; they can also lead to epithelial compromise and erosions that cause patient discomfort. Corneal transplants (full-thickness or anterior lamellar) are an option when a patient reaches a threshold of disability. Unfortunately, transplantation carries significant risk, especially for penetrating keratoplasty, including graft rejection and increased intraocular pressure. Additionally, the dystrophy can recur after transplantation and cause a patient to be symptomatic again. This happened for a 76-year-old female patient (Figure 3) who had granular dystrophy and a penetrating graft of her right eye in 1986. I was able to successfully fit her with a scleral lens that provides her with improved vision.

Preventing or at least delaying a corneal transplant for patients who have a corneal dystrophy by fitting them with scleral lenses is a preferred strategy. For patients who do need a corneal transplant secondary to dense opacification, some will be candidates for scleral lenses postoperatively because of corneal irregularity or dystrophy recurrence. CLS

For references, please visit www.clspectrum.com/references and click on document #302.