This article was originally published in a sponsored newsletter.

The scleral lens category continues to expand. An overview of international contact lens prescribing reported in the January 2023 issue of Contact Lens Spectrum reported that scleral lens growth continues within the rigid contact lens sector. In fact, scleral lenses are 23% of international contact lens fittings.¹

In February 2023, Schornack and colleagues reported international prescribing patterns and management of scleral lenses in various types of practices.² Scleral lens practitioners completed an electronic survey regarding a single scleral lens wearer. Various information was collected including the demographics of practitioners (type of practice, country, years of experience), scleral lens indications, lens design, fitting process, and scleral lens care products. Information was obtained from 419 eyes in 259 patients. The majority of practitioners (60%) were from the U.S. Additionally, most practitioners (58%) had more than five years of experience fitting scleral lenses.
 
Although the scleral lens category continues to expand, there is a tremendous opportunity for scleral lenses to flourish. In the aforementioned study by Schornack and coworkers, the majority of practitioners reported that corneal irregularity was the main indication for scleral lens fitting (87%).² Only 9% of practitioners fit scleral lenses for ocular surface disease, and even fewer (4%) fit lenses for refractive error.

Another publication has reported the advantages of scleral lenses for ocular surface disease.³ All levels of ocular surface disease from mild to advanced disease can benefit from scleral lenses. Scleral lenses offer corneal protection, aid corneal healing, and reduce the frequency of topical lubricants.⁴
 
Success with scleral lenses has been reported for corneas that do not have disease, ectasia, or irregularities, and that do have a regular, normal, prolate shape.³ In the regular cornea category, there may be an overlap with ocular surface disease. Individuals may benefit since scleral lenses can both correct refractive error and are advantageous for ocular surface disease.
 
Another potential category for growth is customized scleral landing zones. In one study, the majority of practitioners reported spherical landing zones (64%).² Approximately one-quarter (26%) were toric, with few having quadrant-specific (7%) or custom (3%) designs.² However, another publication reported that most scleras are not spherical. In a study of 152 eyes of scleral lens wearers, only 5.7% of scleras were spherical.⁵ Accordingly, most landing zones should be customized to match the ocular shape.
 
With modern advanced techniques and scleral lens designs, we have the opportunity to improve our scleral lens fitting, thus improving the experience of scleral lens wearers.

Reference(s):

1. Morgan P, Woods CA, Tranoudis IG, et al. International Contact Lens Prescribing in 2022. Contact Lens Spectrum. 2023 Jan;38:28-35. Available at clspectrum.com/issues/2023/january-2023/international-contact-lens-prescribing-in-2022. Accessed Feb 24, 2023.

2. Schornack MM, Fogt J, Nau A, et al. Scleral lens prescription and management practices: Emerging consensus. Cont Lens Anterior Eye. 2023 Feb;46:101501.

3. Barnett M, Courey C, Fadel D, et al. CLEAR - Scleral lenses. Cont Lens Anterior Eye. 2021 Apr;44:270-288.

4. Stoyanova EL, Otten HM, Wisse R, Rothova A, Riemens A. Bandage and scleral contact lenses for ocular graft-versus-host disease after allogeneic haematopoietic stem cell transplantation. Acta Ophthalmol. 2015 Nov;93:e604.

5. DeNaeyer G, Sanders D, van der Worp E, Jedlicka J, Michaud L, Morrison S. Qualitative Assessment of Scleral Shape Patterns Using a New Wide Field Ocular Surface Elevation Topographer: The SSSG Study. JCLRS. 2017 Nov16;1(1):12-22. Available at jclrs.org/index.php/JCLRS/article/view/11. Accessed Jan. 24, 2023. 

Melissa Barnett, OD, FAAO, FSLS, is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Mojo Vision, Ocusoft, ScienceBased Health, Shire, SynergEyes, Tarsus, and Visus Therapeutics.