Clinical Report: Initiating the Scleral Lens Fit Prior to CXL

Overview

This study evaluates the timing of scleral lens fitting in relation to corneal cross-linking (CXL) in patients with keratoconus and post-LASIK ectasia. Findings suggest that fitting scleral lenses before CXL does not adversely affect corneal measurements and may streamline the lens fitting process postoperatively.

Background

Corneal cross-linking (CXL) is a critical intervention for managing corneal ectasia, yet the optimal sequencing of CXL and scleral lens fitting remains unclear. While CXL stabilizes the cornea, it does not correct refractive errors, necessitating the use of specialty contact lenses for visual rehabilitation. Understanding the timing of these interventions is essential for improving patient outcomes and quality of life.

Data Highlights

No significant differences were observed between pre- and postoperative corneal measurements or refractive corrections in the study cohort.

Key Findings

• Scleral lenses can be safely fitted before CXL without compromising corneal stability.
• The study involved 11 eyes from individuals with keratoconus and post-LASIK ectasia.
• Lens fitting aimed for 200mm to 300mm of central clearance and 50mm to 100mm of limbal clearance.
• Best spectacle-corrected visual acuity (BSCVA) was recorded preoperatively and at one and three months postoperatively.
• Results support the potential to reduce postoperative visits by initiating scleral lens fitting prior to CXL.

Clinical Implications

Clinicians may consider fitting scleral lenses before performing CXL to enhance patient comfort and visual outcomes. This approach could reduce the need for additional follow-up visits, thereby improving the overall efficiency of patient care.

Conclusion

The findings indicate that initiating scleral lens fitting prior to CXL is a viable strategy that may optimize postoperative care and patient satisfaction.

References

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3. Saenz B, Mueller B, Modern Optometry, 2020 -- Scleral Lenses or CXL: Which Should Come First?
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10. Adding Scleral Lenses
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12. Topographical and Refractive Outcomes After Corneal Cross-linking in Novice Scleral Lens Users - PubMed