Clinical Scorecard: Integrating Multifocal Scleral Lenses for Discontented GP Users
At a Glance
| Category | Detail |
|---|---|
| Condition | Discomfort and unsatisfactory near vision in long-term gas permeable (GP) lens wearers with keratoconus and dry eye disease |
| Key Mechanisms | Use of multifocal scleral lenses to improve comfort, stability, and functional vision by addressing lens dislodgement and near vision deficits |
| Target Population | Long-term GP lens wearers with keratoconus, dry eye disease, and dissatisfaction with near vision and lens stability |
| Care Setting | Specialty contact lens clinics with access to scleral lens fitting and follow-up |
Key Highlights
- Multifocal scleral lenses provide improved comfort and stability compared to corneal GP lenses in patients with keratoconus and dry eye.
- Quadrant-specific haptics in scleral lens design can reduce lens decentration and posterior tear film debris.
- Adjusting the near optical zone in multifocal scleral lenses aids neuroadaptation and optimizes near vision without compromising distance vision.
Guideline-Based Recommendations
Diagnosis
- Perform tomography scans and manifest refraction to assess ocular status and refractive error.
- Evaluate patient history for dry eye disease, lens dislodgement, and near vision complaints.
Management
- Trial fitting of scleral lenses to assess comfort and stability improvements over GP lenses.
- Use quadrant-specific haptics to customize lens fit and reduce decentration.
- Consider multifocal scleral lenses for patients seeking improved near vision without reading glasses.
- Adjust near optical zone in multifocal lenses based on patient adaptation and visual needs.
Monitoring & Follow-up
- Follow up to assess comfort, lens stability, and visual acuity at distance, intermediate, and near.
- Monitor for posterior tear film debris and lens fogging; adjust fit as needed.
- Counsel patients on neuroadaptation period for multifocal lenses and manage expectations.
Risks
- Potential lens decentration causing tear film debris and fogging.
- Adaptation difficulties with multifocal lenses, especially for near vision.
Patient & Prescribing Data
53-year-old male with keratoconus, dry eye disease, and 25-year history of RGP lens use
Multifocal scleral lenses improved comfort and stability immediately; near vision improved after adjusting near optical zone and neuroadaptation, achieving 20/20-2 distance and J1 near vision.
Clinical Best Practices
- Engage in detailed patient counseling regarding multifocal scleral lens adaptation and realistic visual outcomes.
- Customize scleral lens fit using quadrant-specific haptics to enhance comfort and reduce complications.
- Perform over-refraction after trial fitting to optimize near addition power.
- Schedule regular follow-ups to monitor lens fit, comfort, and visual performance.
References
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