Clinical Scorecard: The Scleral Lens Vault: The Eye Under Pressure

At a Glance

Key Highlights

• Compression of anterior chamber structures occurs during scleral lens wear.
• Parameters such as anterior chamber depth, angle opening distance, and trabecular-iris space area are affected.
• Central corneal thickness increases by 2.29% during lens wear.
• Ocular structures return to baseline quickly after lens removal.
• Consideration of alternative lens options is advised for patients at risk.

Guideline-Based Recommendations

Diagnosis

• Assess anterior chamber parameters using AS-OCT before fitting scleral lenses.

Management

• Exercise caution when fitting scleral lenses in patients with glaucoma or narrow angles.

Monitoring & Follow-up

• Monitor ocular health and anterior chamber parameters during scleral lens wear.

Risks

• Compression may restrict aqueous humor outflow, potentially increasing intraocular pressure.

Patient & Prescribing Data

Healthy Asian individuals aged 18 to 35 years.

Scleral lenses should be fitted with consideration of their impact on anterior chamber dynamics.

Clinical Best Practices

• Promote tear exchange under the lens to mitigate compression effects.
• Consider fenestrations to limit suction effects, though outcomes may vary.

References

• Jiang et al, 2025
• Vincent et al, 2017
• Nau et al, 2016
• Costagliola et al, 2020
• Samaha and Michaud, 2021
• Michaud et al, 2025
• Cheung et al, 2020
• Fisher et al, 2024