AS SCLERAL LENSES become more customizable and accessible, they are proving essential in optometric practice. With this growth comes the potential for more barriers to scleral lens wear. It is important to prepare patients, staff, and ourselves for these challenges to ensure success for all involved.

BARRIER NO. 1: COST

It is no secret that scleral contact lens fitting involves a larger financial commitment compared to refractive correction alternatives. Lens materials, diagnostic equipment, and chair time all contribute to the total fees. Patients may be aware of this trend based on research, word of mouth, or price quotes from an office. It is critical to set prices that are fair to the patient and the practice, as well as relevant to the ever-changing economy.

The provider must feel comfortable with his or her fee structure and openly educate the patient on the value of the service being offered. Examination and material fees should not be a surprise at checkout. Patients are generally appreciative when given cost estimates, and it is in their best interest to optimize billing and coding for any insurance coverage.

BARRIER NO. 2: TIME

In addition to financial obligations, another barrier to entry into scleral contact lens wear is the time commitment. Multiple lens remakes may be necessary to perfect a fit, and the wait time on a lens order from some specialty labs can be several weeks. Some patients who have complex ocular disease may require additional time and attention from the practitioner, cutting into other examination slots.

Resources such as corneoscleral mapping technology can
expedite the fitting process, and lens warranty periods up to 120 days provide a buffer for manufacturing delays. Scheduling patients with ample time to complete a successful scleral fit and setting reasonable timing expectations for them can also help providers overcome these challenges. Additionally, utilizing the technician team for support can enable providers to make the most of the time they have with the patient.

BARRIER NO. 3: LENS HANDLING

Scleral lenses come with additional supplies and tools that may not be familiar to patients. Large diameter lenses, filling solutions, and plungers can be intimidating at first—so much so that lens handling is one of the most common reasons for scleral lens dropout (Macedo-de-Araújo et al, 2020). Patients deserve attentive, encouraging training on lens application, removal, cleaning, and care.

Whether due to orbital anatomy, finger size, or other agility limitations, some patients may struggle with lens application and removal. There are now numerous resources available to simplify the process, from assisted lens application stands to web-based training videos. It can also be helpful to offer patients an “on-the-go scleral lens kit” containing the necessities.

OVERCOMING BARRIERS

Successful scleral contact lens fitting begins with the provider; we must choose at least one lens design to work with, educate ourselves on the intricacies of that design, advertise our services, and offer said services to appropriate candidates. Beyond this, our duty is to prepare for and address the barriers previously mentioned to ensure positive patient outcomes. These barriers are all, to some degree, controllable elements, and our patients deserve our best efforts to overcome them.

REFERENCES

1. Macedo-de-Araújo RJ, van der Worp E, González-Méijome JM. A One-Year Prospective Study on Scleral Lens Wear Success. Cont Lens Ant Eye. 2020 Dec;43:553-561.