Management of contact lens patients with pingueculae or pterygia

Frugal Method of Notch Modification of Scleral Contact Lenses in the Setting of Complex Ocular Surface Anatomy

ABSTRACT

Scleral contact lenses (ScCLs) have gained popularity as a treatment of refractive errors in patients with complex anterior segment pathology. Patients with mechanical abnormalities of the ocular surface may be unsuccessful with traditional ScCL fitting. Scleral contact lens modifications, such as notching and microvaulting, typically incur additional financial costs and require the services of professional laboratories. We describe a frugal method of ScCL notch modification that can be performed by a practitioner using readily available tools in a single office visit. Two patients with abnormal ocular surface anatomy were fit with the practitioner-modified ScCL and achieved successful visual rehabilitation. We offer this method as a potentially economical and effective technique to achieve successful ScCL fitting in this challenging patient population with pathologies that may preclude standard ScCL usage.

Anatomical and physiological considerations in scleral lens wear: Conjunctiva and sclera

While scleral lenses have been fitted using diagnostic lenses or impression moulding techniques for over a century, recent advances in anterior segment imaging such as optical coherence tomography and corneo-scleral profilometry have significantly improved the current understanding of the anatomy of the anterior eye including the morphometry of the conjunctiva, sclera, and corneo-scleral junction, as well as the ocular surface shape and elevation. These technological advances in ocular imaging along with continual improvements and innovations in scleral lens design and manufacturing have led to a global increase in scleral lens prescribing. This review provides a comprehensive overview of the conjunctiva and sclera in the context of modern scleral lens practice, including anatomical variations in healthy and diseased eyes, the physiological impact of scleral lens wear, potential fitting challenges, and current approaches to lens modifications in order to minimise lens-induced complications and adverse ocular effects. Specific topics requiring further research are also discussed.