A PATIENT CHALLENGED by high astigmatism reminded me of the important link between clear vision and quality of life. This 31-year-old male presented for an eye exam with complaints of poor vision and discomfort related to his rigid GP lens wear. He reported having had astigmatism for as long as he could remember.

However, over the last two years he had become increasingly unhappy with his contact lenses. He described his frustration with both distance and near vision and while playing basketball and tennis.

His refraction revealed:

OD: –5.75 –3.75 x 150 20/20

OS:–5.00 –3.25 x 007 20/20

Keratometry readings included:

OD: 51.00 @ 063 and 47.25 @ 153

OS: 47.00 @ 095 and 43.75 @ 005

Surprisingly, corneal topography did not show signs of keratoconus. After patient education, we decided upon mini-scleral lenses with the goals of good vision, comfort, and easy application and removal. A trial lens set was utilized and ultimately, the right lens needed to be refit one time due to discomfort and the left lens was only fit once.

After two weeks of wear with the final prescription, the patient returned for a follow-up. He was amazed at the quality of his vision, both distance and near, and that he could wear the lenses comfortably for 12 hours per day. He used artificial tears as necessary when he was at work.

He was extremely pleased that sports, computer work, and daily living activities were noticeably easier and more enjoyable. He commented that this was the clearest his vision had ever been.

WHY MINI-SCLERAL LENSES?

Like this patient, individuals who have high astigmatism are often challenged by poorly corrected visual acuity and subsequent decreases in quality of life. Depending on the specific lens, mini-scleral lenses have the ability to correct significant amounts of regular and irregular astigmatism, while offering a thinner lens profile with minimal lens edge and lid interaction to enhance comfort (Blanchard Lab, 2024).

The posterior surface of a mini-scleral lens helps to eliminate regular and irregular corneal astigmatism, while the front aspheric surface reduces aberrations to further improve vision (Blanchard Lab, 2024). Plus, athletes can benefit from the stability provided by the contoured fit of mini-scleral lenses, reducing the chances of lenses dislodging during physical activity.

Mini-scleral lenses are made of materials that have a minimum Dk of 100 with the goal of promoting oxygen transmission and maintaining corneal health (Blanchard Lab, 2024). With a wide range of parameters to choose from, eyecare providers are able to design customized mini-scleral lenses so that vision and comfort can be maximized for patients challenged by irregular corneas or high amounts of astigmatism.

Mini-scleral lenses are typically 15.0mm to 18.0mm in diameter and have been associated with streamlined fitting. One recent study reported that the mean number of lenses required for a successful fitting was 1.1 (Kreps et al, 2021).

Mini-scleral lenses have also been associated with significantly improved visual acuity when compared to previous habitual visual acuity, as well as wear times of 12 hours per day on average. In addition, mini-scleral lenses have shown significant improvements in vision-related quality of life measurements for distance and near activities as well as for role difficulties (Kreps et al, 2021).

While high astigmatism can cause visual challenges for patients, the good news is that treatment is readily available to maximize their quality of life.

REFERENCES

1. Blanchard Lab. Blanchard U / MSD Select. 2024. Available at blanchardlab.com/blanchard-u/products/msd-select. Accessed 2024 Apr 21.

2. Kreps EO, Pesudovs K, Claerhout I, Koppen C. Mini-Scleral Lenses Improve Vision-Related Quality of Life in Keratoconus. Cornea. 2021 Jul;40:859-864.