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Contact Lens Spectrum

Article

Initiating the Scleral Lens Fit Prior to CXL

Corneal cross-linking (CXL) is universally accepted in the management of corneal ectasia; however, there are fewer publications on the sequencing or timing of when CXL or scleral lenses should be performed.

By: Melissa Barnett, OD, FAAO, FSLS
Contact Lens Spectrum February 10, 2025

Clinical Scorecard: Initiating the Scleral Lens Fit Prior to CXL

At a Glance

CategoryDetail
ConditionCorneal ectasia
Key MechanismsCorneal cross-linking (CXL) stabilizes the cornea but does not correct corneal irregularity.
Target PopulationIndividuals with keratoconus or post-LASIK corneal ectasia.
Care SettingOphthalmology clinics specializing in corneal treatments.

Key Highlights

  • CXL is not a refractive procedure and does not improve BSCVA.
  • Scleral lenses can be fitted before CXL to improve vision for daily activities.
  • No significant differences in corneal measurements or refractive correction pre- and postoperatively.
  • Scleral fittings before CXL may streamline the lens prescription process.
  • Scleral lenses can be safely resumed one month post-CXL.

Guideline-Based Recommendations

Diagnosis

  • Evaluate topographical signs and objective evidence for significant progression.

Management

  • Consider scleral lens fitting prior to CXL for patients with unacceptable vision.

Monitoring & Follow-up

  • Record topographic and refractive parameters, BSCVA, and best scleral visual acuity preoperatively and at one and three months postoperatively.

Risks

  • Potential for no improvement in corneal measurements postoperatively.

Patient & Prescribing Data

Patients with keratoconus or post-LASIK corneal ectasia.

Scleral lenses provide improved vision and may reduce postoperative visits.

Clinical Best Practices

  • Fit scleral lenses with 200mm to 300mm of central clearance and 50mm to 100mm of limbal clearance.
  • Use sphero-cylindrical overrefraction to determine lens power.

References