LEARNING METHOD AND MEDIUM
This educational activity consists of a written article and 20 study questions. The participant should, in order, read the Activity Description listed at the beginning of this activity, read the material, answer all questions in the post test, and then complete the Activity Evaluation/Credit Request form. To receive credit for this activity, please follow the instructions provided below in the section titled To Obtain CE Credit. This educational activity should take a maximum of two hours to complete.
CONTENT SOURCE
This continuing education (CE) activity captures key
statistics and insights from contributing faculty.
ACTIVITY DESCRIPTION
In this article, the author will discuss the research on scleral lenses conducted by the SCOPE (Scleral Lenses in Current Ophthalmic Practice Evaluation) group over the past 10 years.
TARGET AUDIENCE
This educational activity is intended for optometrists, contact lens specialists, and other eyecare professionals.
ACCREDITATION DESIGNATION STATEMENT
This course is COPE accredited for two hours of CE credit.
COPE Course ID: 91347-CL
COPE Activity ID:
DISCLOSURES
Jennifer Swingle Fogt, OD, MS, has received remuneration from Envision Biomedical and TearOptix and has a research grant or contract with Alcon, Cooper Vision, Bausch + Lomb, Vyluma, Eyenovia, Interojo, and VizionFocus.
DISCLOSURE ATTESTATION
The contributing faculty member has attested to the following:
1. That the relationships/affiliations noted will not bias or otherwise influence her involvement in this activity;
2. That practice recommendations given relevant to the companies with whom she has relationships/affiliations will be supported by the best available evidence or, absent evidence, will be consistent with generally accepted medical practice;
3. That all reasonable clinical alternatives will be discussed when making practice recommendations.
TO OBTAIN CE CREDIT
To obtain COPE CE credit for this activity, read the material in its entirety and consult referenced sources as necessary. We offer instant certificate processing for COPE credit. Please take the post test and evaluation online by using your OE tracker number and logging in to visioncarece.com.
Upon passing the test, you will immediately receive a printable PDF version of your course certificate for COPE credit. On the last day of the month, all course results will be forwarded to ARBO with your OE tracker number, and your records will be updated. You must score 70% or higher to receive credit for this activity. Please make sure that you take the online post test and evaluation on a device that
has printing capabilities.
NO-FEE CONTINUING EDUCATION
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Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Contact Lens Spectrum. This activity is copyrighted to BroadcastMed LLC ©2024. All rights reserved.
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Release date:June 1, 2024
Expiration Date: May 3, 2027
IN 2014, the Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) group began with the goal of performing translational clinical research to inform scleral lens prescription and management. The first SCOPE research project was conducted in 2015, and was a survey developed by the group and deployed by email to members of the Scleral Lens Education Society and both the Section on Cornea, Contact Lenses and Refractive Technologies of the American Academy of Optometry and the Contact Lens & Cornea Section of the American Optometric Association. This 2015 survey asked scleral lens fitters to describe their training, current mode of practice, estimates of the number of scleral lenses they had fit, and specific questions about their experiences and methods when fitting scleral lenses.1
Nearly 1,000 eyecare providers responded to the survey, with 723 respondents reporting that they had fit five or more patients with scleral lenses.1 The total number of scleral lens patients described by these respondents was more than 84,000, which was considerably higher than the 40,000 scleral lens patients estimated to exist by industry analysts at that time.
The survey found that scleral lenses were being fit more commonly by practitioners in private practice settings (63%) compared to academic, research, or hospital settings. Results also showed that the majority of scleral lens prescribers fit their first scleral lens in 2009 or later, and 65% of the providers had fit 50 or fewer scleral lenses. Despite this, the average number of scleral lenses fit by respondents was 125 lenses.2
Corneal irregularity was the most common indication for scleral lens fittings. In 2015, 277 respondents ranked corneal GP lenses as their first lens choice for fitting irregular corneas, as opposed to 217 who ranked scleral lenses as their first lens choice. Ocular surface disease was the second most common indication for scleral lens fittings, and fitting lenses for this indication was ranked as the sixth treatment option for ocular surface disease management.3
Responses to questions about lens-related issues and complications showed that problems related to scleral lens wear were relatively rare and generally not sight-threatening.
The second SCOPE survey asked practitioners to provide information on their most recently evaluated scleral lens patient.4 Two hundred ninety-two responses representing 734 patient years of lens wear were collected.
Examination data was collected and analyzed and there were some notable findings, including the high usage of spherical haptic zones for scleral lenses (64%), despite the availability of toric and quadrant-specific haptics at that time, and the improvements in the ocular surface when comparing the presence of corneal staining before and after prescription of scleral lenses in these patients. This study also found that the mean number of scleral lenses ordered during the fitting process was 2.4.
The data collected in this paper found that midday fogging occurred in 25.8% of the patients evaluated, and no lens properties or solution use were associated with this complication. The only factor found to be associated with reported midday fogging was eye redness, which suggests that inflammation may be contributing to this phenomenon.5
With a goal of better understanding aspects from the patient perspective, the SCOPE study group designed a third survey to be patient facing, asking patients who had keratoconus about their age at diagnosis, treatments since diagnosis, contact lens complications, access to care, and burden of lens use, including time and financial burdens. This study found that wearers of both corneal and scleral lenses experienced cloudy vision and lens discomfort, with scleral lens wearers reporting greater satisfaction with vision and comfort.6
A survey launched at the Global Specialty Lens Symposium in 2017 was designed to compare the ideal scleral lens fitting characteristics of methods of evaluation by experienced and new eyecare providers.7 In this survey, experienced scleral lens prescribers (those who had more than five years of fitting experience) tended to fit lenses based upon sagittal depth, used a threshold between 150µm and 500µm for central clearance (now referred to as post-lens tear fluid depth) and 100µm to 300µm of limbal clearance, and assessed the cornea and conjunctiva during and after lens removal at examinations. Less experienced prescribers tended to fit lenses with less central clearance, and fewer of these fitters had patients remove their lenses to evaluate the cornea and conjunctiva after wearing their scleral lenses.7
The SCOPE study group’s second patient-centric survey was designed in 2018 to learn more about the experiences of individuals who had ocular surface disease, including—but not limited to—people who wear scleral lenses for treatment of their disease.8 In this study, people who had symptoms of dry eye completed the Ocular Surface Disease Index (OSDI) and answered questions about their initial and current treatments for ocular surface disease.
Interestingly, responses from those wearing scleral lenses for their ocular surface disease revealed higher OSDI scores, which is likely due to scleral lenses being used more in those patients who had more severe disease. Of those wearing scleral lenses, 75% reported experiencing lens fogging or clouding of vision during wear.8
In order to better understand some conflicting study findings regarding a relationship between intraocular pressure (IOP) and scleral lens wear, the SCOPE study group conducted its first prospective clinical study in 2019. In this study, 20 participants wore a small-diameter scleral lens (15.2mm) and a large-diameter scleral lens (18.0mm) in a randomized order.9 IOP was assessed before, during, and after lens wear with each lens, using two devices: a transpalpebral tonometer and a pneumotonometer, both of which can assess IOP peripherally while the patient is wearing a scleral lens.
This study found that IOP measurements during lens wear were statistically significant when assessed with the transpalpebral tonometer but not when assessed with pneumotonometry, which explained why studies using different methods of IOP measurement found conflicting results in previous research. The authors concluded that evaluation of the optic nerve remains an important method of monitoring the ocular health of scleral lens wearers and all patients.9
In 2020, the SCOPE study group, like many optometrists, were excited to embark on a year with a vision-related number. The five-year anniversary of the SCOPE study group’s first survey was an opportunity to look for changes in the scleral lens world. So, a survey of scleral lens fitting practices was deployed. Fortunately, data collection was not interrupted by the COVID pandemic that had put much research on hold.
Similar to the 2015 survey, this survey gathered responses from close to 1,000 practitioners. Of the 922 respondents, 858 had fit five or more scleral lenses, and there were a total of 213,465 scleral lens fits.10 The average number of lenses fit per practitioner was 284 in 2020, compared to 125 in 2015. Corneal irregularity remained the most common indication for scleral lens wear, with scleral lenses surpassing corneal rigid lenses as the preferred treatment of these patients. Scleral lenses remained the sixth ranked treatment used for the management of ocular surface disease in the 2020 survey. Providers who responded to the survey showed an increased use of scleral lenses outside of the U.S. in 2020, with 64 other countries being represented, as compared to 49 other countries in 2015.
One impactful result of this survey was an estimate of the frequency of complications from scleral lens wear, including corneal edema (0.40%), neovascularization (0.18%), and microbial keratitis (0.15%).11
Because most practices fit a relatively small number of scleral lenses, it will take much time to conduct a large, multisite prospective study to report on the incidence of complications, yet this information is of great interest and importance to those whose eyes are often compromised before scleral lens wear.
A multisite review of impression-based scleral devices was published by the SCOPE study group in 2020.12 In this study, 70 eyes were fit, including 44 eyes with corneal irregularity and 26 eyes with ocular surface disease as the primary indication. Forty percent of those patients fit with impression-based lenses had been unsuccessfully fit with standard scleral lenses previously. In this study, ideal haptic alignment was achieved in 74% of eyes and complete central and limbal clearance was achieved in 83% of eyes.
The SCOPE study group conducted a survey of optometric educators, finding that most schools initiated scleral lens education during the third year of optometry school, and the number of scleral lens fittings that students performed during optometry school ranged from 2 to 100.13 Educators were found to concentrate on teaching students to use basic assessment strategies rather than advanced imaging.
A SCOPE survey of graduating fourth-year optometry students revealed similar findings, with students reporting clinical experiences with scleral lenses ranging from 0 to 110 fits.14
The SCOPE study group was privileged to work with individuals during their advanced contact lens residencies and fellowships and publish a paper on the process and outcomes of fitting scleral lenses for ocular surface disease based upon corneoscleral profilometry.15 The group truly enjoyed mentoring and working with these two exceptional optometrists early in their careers, and looks forward to seeing their future contributions to the field.
Overall, the research of the SCOPE study group has played a large role in understanding the prescription and use of scleral lenses over the past 10 years. To date, the SCOPE study group has had 22 peer-reviewed manuscripts (cited 387 times to date) and 56 peer-reviewed abstracts published.
The SCOPE study group is continuing to look to the future and has additional projects in progress. The group is currently busy conducting multisite clinical studies in addition to its surveys; a recent publication on their research evaluates the impact of lens properties and solutions on midday fogging.16 Publications on both the group’s recent surveys and its clinical work are forthcoming, and two additional studies are currently underway.
Acknowledgment: The author would like to acknowledge the SCOPE group for their constant support of each other and their ability to work hard and sparkle simultaneously.
REFERENCES
1. Harthan J, Nau CB, Barr J, et al. Scleral Lens Prescription and Management Practices: The Scope Study. Eye Contact Lens. 2018 Sep;44 Suppl 1:S228-S232.
2. Nau CB, Harthan J, Shorter E, et al. Demographic Characteristics and Prescribing Patterns of Scleral Lens Fitters: The Scope Study. Eye Contact Lens. 2018 Sep;44 Suppl 1:S265-S272.
3. Shorter E, Harthan J, Nau CB, et al. Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease. Eye Contact Lens. 2018 Nov;44:372-378.
4. Schornack M, Nau C, Nau A, Harthan J, Fogt J, Shorter E. Visual and physiological outcomes of scleral lens wear. Cont Lens Anterior Eye. 2019 Feb;42:3-8.
5. Schornack MM, Fogt J, Harthan J, et al. Factors Associated with Patient-Reported Midday Fogging in Established Scleral Lens Wearers. Cont Lens Anterior Eye. 2020 Dec;43:602-608.
6. Shorter E, Schornack M, Harthan J, et al. Keratoconus Patient Satisfaction and Care Burden with Corneal Gas-Permeable and Scleral Lenses. Optom Vis Sci 2020 Sep;97:790-796.
7. Harthan J, Shorter E, Nau C, et al. Scleral Lens Fitting and Assessment Strategies. Cont Lens Anterior Eye. 2019 Feb;42:9-14.
8. Shorter E, Harthan J, Nau A, et al. Dry Eye Symptoms in Individuals with Keratoconus Wearing Contact Lenses. Eye Contact Lens. 2021 Sep 1;47:515-519.
9. Fogt JS, Nau CB, Schornack M, et al. Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure During Scleral Lens Wear. Optom Vis Sci. 2020 Sep;97:711-719.
10. Schornack MM, Nau CB, Harthan J, Shorter E, Nau A, Fogt J. Current Trends in Scleral Lens Prescription, Management, and Evaluation. Eye Contact Lens. 2023 Feb 1;49:56-62.
11. Schornack MM, Nau CB, Harthan J, et al. Survey-Based Estimation of Corneal Complications Associated with Scleral Lens Wear. Eye Contact Lens. 2023 Mar 1;49:89-91.
12. Nau A, Shorter ES, Harthan JS, et al. Multicenter Review of Impression-Based Scleral Devices. Cont Lens Anterior Eye. 2021 Oct;44:101380.
13. Harthan JS, Schornack M, Nau CB, Nau AC, Fogt JS, Shorter ES. Current U.S. based optometric scleral lens curricula and fitting recommendations: SCOPE educators survey. Cont Lens Anterior Eye. 2021 Jun;44:101353.
14. Harthan J, Fogt J, Schornack MM, et al. Graduating Optometry Student Perceptions of Their Scleral Lens Fitting Knowledge. Optom Educ. 2023 Summer;48:27-30.
15. Yoon H, Harthan J, Skoog W, et al. Process and Outcomes of Fitting Corneoscleral Profilometry-Driven Scleral Lenses for Patients with Ocular Surface Disease. Presented at the Global Specialty Lens Symposium. 2023 Jan., Las Vegas.
16. Fogt JS, Nau C, Harthan J, et al. Lens and solution properties in patients with and without midday fogging. Ophthalmic Physiol Opt. 2024 Jun;44:769-773.
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