These days, there is technology for everything and everyone. I’m sure that we all have our love-hate relationship with technology (hello electronic health records!). Over the last year or two, we have seen a shift from traditional in-person patient care visits to virtual or telehealth patient visits, which may be more convenient for patients. For specialty lens fitting, I personally have not found this type of visit to be helpful; but with respect to technology, more tools are readily available to aid us with the fitting process and to potentially reduce chair time.

Corneal GP Empirical Fitting

For corneal GP lenses, many have been utilizing empirical fitting for years. This can include calling a consultant with a patient’s refraction and keratometry readings or providing a consultant with a topography map. From that, a corneal GP lens can be generated, with quite a good result in many cases.

The same can be said for orthokeratology (ortho-k), in which the refraction, corneal curvature, horizontal visible iris diameter, corneal eccentricity (degree of curvature from central cornea to periphery), and pupil size are collected. This data is then submitted to generate an empirically designed ortho-k lens, with overall good initial success rates (El Hage et al, 2007; Lipson, 2020).

Beyond Corneal GP Lenses

Profilometry is a technique used to measure and extract topographical data from a surface, such as the eye. Several instruments using profilometry have been developed to measure the corneoscleral shape to aid in designing scleral lenses (Fadel, 2018; Macedo-de-Araújo et al, 2019). We know that the sclera becomes more toric or asymmetric as it goes further beyond the limbus (Macedo-de-Araújo et al, 2019; van der Worp, 2016). Knowing the shape of the eye has become an imperative part of scleral lens fitting in terms of obtaining an optimal fit and improving patient comfort.

Profilometry can provide user-friendly data of up to 20mm in chord length, which is more than ample for the majority of scleral lens fits (DeNaeyer et al, 2017). These instruments collect hundreds of data points from a patient’s eye and produce a three-dimensional image. The data can be applied to many commercially available scleral lenses to aid in initial lens design and to provide a predictive model that generates a scleral lens custom-tailored to that patient’s eye.

Additionally, software can be added to corneal topographers that can assist in capturing scleral topography data points, which can help eyecare providers understand the landscape of the sclera and help with lens design. Finally, the holy grail of scleral lens design may be impression-based models, in which an impression of the eye is used to generate an initial scleral lens design.

But Is the Technology Enough?

While technology and advancements in equipment can potentially help improve chair time, is it a substitute for eyecare practitioners? Will technology advance to a point at which we are no longer needed?

I know for a fact that as great as technology is, we still need a human and critical thinking behind the technology for troubleshooting or to make any changes that an empirical design may not consider. How many times have you found yourself in the self-checkout line at the store to speed things up or to avoid a long line only to wait for an attendant to assist with some issue that has arisen as a result of the technology? Technology may make things easier on initial encounters, but I wonder how it will impact long-term and follow-up care. Time will tell! CLS

For references, please visit www.clspectrum.com/references and click on document #314.