AT THE START of each new year, it’s traditional to draw up a game plan by making resolutions. Some last, while others are abandoned depending on life’s ups and downs. As a scleral lens fitter, what are your resolutions for 2025? Here are mine—and let’s hope they all stick.

1. BETTER PATIENT SELECTION

On the one hand, it is illusory to think that all eyecare practitioners (ECPs) and contact lens fitters will convert to scleral lenses. Many have, but some who have attended training courses and hands-on workshops have simply abandoned this method of correction for their patients for any number of good reasons—and this is perfectly fine. Clinical experience has also confirmed that scleral lenses are not necessarily for everyone (Lipson, 2016). So, in 2025, it is more important than ever to select the right patients to optimize chair time and, above all, to better serve patient needs.

To start, eliminate patients who, after appropriate training, can’t handle the lenses during the diagnostic phase. Handling remains the number one factor in scleral lens fitting failure (Macedo-de-Araújo et al, 2020). Also eliminate patients who have unrealistic expectations about their vision (Bennett et al, 1998). Scleral lenses are helpful but should not be considered a magic bullet.

Reconsider fitting patients who have keratoconus and whose vision can be corrected to 20/30 or better with glasses in sclerals (Michaud, 2023). A significant number of residual higher-order aberrations can persist despite a perfect lens fit (Nguyen et al, 2020). If the gain in visual acuity is minimal compared to that gained with spectacles, these aberrations can worsen vision to the point that patients will give up.

Budget/insurance coverage is also an issue to discuss when considering scleral fitting. A patient must sign a consent form detailing the procedures, costs, warranties, etc., just like the ones used for orthokeratology lens fitting for myopia management; this will be useful to avoid misunderstandings.

2. RELY MORE ON TECHNOLOGY

It is now possible to design a custom lens to fit a patient’s ocular profile using profilometry. Ideally, this is done using software and importing the profilometer scans. But it is also possible to simply send them to the lab, where the consultants will help the ECP to determine the best options. The empirical fitting method is more efficient and saves chair time, and is also a better experience for patients (Maller, 2021).

3. STOP LOOKING FOR THE PERFECT LENS

In the past, I tried to aim for perfection by modifying lenses every time. This meant changing lenses and reordering them a lot. With experience, I realized that it was pointless. Was it really necessary to add that –0.75D front toric power that made the difference in over-refraction but which, once incorporated into the lens, didn’t give better results? This type of toric power is often a decoy. It is more a way of correcting a coma—due to the lens decentration—than a true residual astigmatism (Sabesan, 2013). Now, I try to limit myself to a maximum of one or two exchanges per eye. A good habit to keep.

4. KEEP UP TO DATE WITH TECHNOLOGICAL OPTIONS

Proactive manufacturers improve their designs on a regular basis by offering new options. Correcting aberrations on the front surface of the lens will undoubtedly be the next wave. We must not lose sight of the contribution of artificial intelligence in helping us to design the best lens profiles. Yesterday’s problems may be solved by tomorrow’s technology.

By applying these resolutions, I will undoubtedly look back with satisfaction on the management of my scleral lens-fitted patients in 2025. I wish you the same.

REFERENCES

1. Lipson M. When to opt for scleral lenses. Rev. Cornea Contact Lens. 2016 Nov. Available at reviewofcontactlenses.com/article/when-to-opt-for-scleral-lenses. Accessed 2024 Nov 10.

2. Macedo-de-Araújo RJ, van der Worp E, González-Méijome JM. A one-year prospective study on scleral lens wear success. Cont Lens Anterior Eye. 2020 Dec;43:553-561.

3. Bennett ES, Stulc S, Bassi CJ, et al. Effect of patient personality profile and verbal presentation on successful rigid contact lens adaptation, satisfaction and compliance. Optom Vis Sci. 1998 Jul;75:500-505.

4. Michaud, L. Daniel’s Rule. Contact Lens Spectrum. 2023 Oct;38:44. Available at clspectrum.com/issues/2023/october/the-scleral-lens-vault. Accessed 2024 Nov 11.

5. Nguyen LC, Kauffman MJ, Hastings GD, Applegate RA, Marsack JD. Case Report: What Are We Doing for Our “20/20 Unhappy” Scleral Lens Patients? Optom Vis Sci. 2020 Sep;97:826-830.

6. Maller K. Empirical Fitting of Specialty GP Lenses. Contact Lens Spectrum. 2021 Aug; 36:28,30-33, 51. Available at clspectrum.com/issues/2021/august/empirical-fitting-of-specialty-gp-lenses. Accessed 2024 Nov 11.

7. Sabesan R, Johns L, Tomashevskaya O, Jacobs DS, Rosenthal P, Yoon G. Wavefront-guided scleral lens prosthetic device for keratoconus. Optom Vis Sci. 2013 Apr;90:314-323.