Scleral Contact Lenses – An Answer To Many Patient’s Eye Problems

24th February, 2010 - Posted by Dr. S. Barry Eiden - 7 Comments

Scleral contact lenses are large diameter gas permeable lenses that are fit to “vault” the entire surface of the cornea and rest on the far less sensitive white of the eye called the sclera. The advantages that scleral lenses provide include; significantly greater comfort vs. corneal rigid lenses, excellent positioning of the lens centrally over the eye to provide optimal vision correction especially in cases of highly irregular cornea surfaces (as occurs with diseases such as keratoconus or following eye surgeries such as cornea transplants and poor outcomes with LASIK eye surgery). In addition, scleral lenses provide a consistent pool of tears beneath the lens and as such can be a solution for patients with severe dry eye disease.

Very few eye care specialists (optometrists or ophthalmologists) are skilled in the fitting of scleral lenses. However, those that are can provide care for patients who have exhausted all other options.

   Scleral Contact Lens On An Eye

One example of a person who benefited from the fitting of scleral contact lenses at North Suburban Vision Consultants is J.M., an 81 year old gentleman who suffered a severe herpes eye infection of his left eye a number of years ago. He ended up requiring a corneal transplant, however it was not successful. The outcome was a scared eye with recurrent erosion of the surface cells. Not only was the eye functionally blind, but it was very painful. Various medications were attempted to address the erosion of the corneal surface as were bandage soft contact lenses and even other surgical procedures. All failed. He was referred by his corneal surgeon to NSVC for scleral contact lens fitting in order to promote surface corneal healing. At the initial visit we were able to fit him in a large diameter scleral contact lens that provided immediate improvement in his comfort. J.M. did not want us to take off the lens! He has worn the scleral lens now for over 2 years and has been able to be comfortable all day long without pain. If the fitting of the scleral lens had been unsuccessful his only other choice would have been to remove the eye and have an artificial eye put in its place. J.M. is so very happy that we were able to avoid this from happening.

This is just one of many wonderful cases where a scleral contact lens has had dramatic impact on one of our patient’s lives.

We welcome questions or comments about scleral contact lenses on our blog.

7 Comments

Joe Becht

April 29th, 2010 at 11:18 am    


I had LASIK in 1999 and 2000. My vision was great after the enhancement but in 2008, I noticed regression and an increase in higher order aberrations. I have since seen a few doctors who have helped in the way of glasses, Synergeyes PS lenses and Alphagan P. I am inquiring as to whether a scleral lens with a larger optical zone could help further. I have been offered more surgery but am very reluctant to proceed this way.

Thank you for your time.

Dr. S. Barry Eiden

April 30th, 2010 at 7:58 am    


The use of scleral contact lenses for the vision correction of multiple causes of corneal irregularity has gained popularity over the past few years due to advances in designs and materials. Joe, you are correct in thinking that scleral lenses might provide advantages for you in comparison to vision with glasses or other contact lens designs. The Synergeyes PS lens is a hybrid lens with a gas permeable center and soft periphery. It utilizes a special “reverse geometry” design to better align with the post surgical cornea shape often resulting from LASIK (which is a flatter curve in the center and a steeper curve in the mid-periphery of the cornea). Problems with this lens include inadequate vision correction, but more commonly eye inflammation and irritation associated with tightening of the lens on the eye following a short wearing time. The use of Alphagan-P for post refractive surgery vision distortions and increased high order aberrations is also a common finding. The eye drop will mildly reduce pupil size temporarily. This limits the perception of vision distortions due to high order aberrations. Although effective, it is not a desired method since it requires the use of a medication for long periods of time.

The advantages of scleral contact lenses include vision correction and reduction of high order aberrations induced by irregular post surgical corneal shapes, the ability to modify parameters such as optic zone size according to the needs of the patient, and the generally excellent comfort provided by lenses that “land” on the scleral surface (vs. the cornea).

I hope this helps you and I urge you to consult with a contact lens specialist who has extensive experience in the managment of post surgical patients and in the fitting of scleral lenses.

Best of luck!

Dr. Eiden and North Suburban Vision Consultants, Ltd.

ankit sachdev

September 26th, 2010 at 4:44 pm    


Respected Sir,
This is Ankit Sachdev from India.I have undergone lasik surgery in june,2007 , since then my vision has been fine but i am suffering from night problems like glare , halos and starbursts which is a big problem for me being a pilot.Most of the doctors i have seen here are saying that as my pupil dilates more than the treatment zone at night then the problem comes.I read lot about the post surgical scleral lenses through net.I wanna take your opinion sir that can these lenses be really be helpful in my case.Can these lenses also provide me more crisper and sharper vision which i have lost after lasik.I am sure you have treated 100′s of patients with a similar problem.Hope to get a positive reply.Thnx!!!

Regards,
Ankit Sachdev.

Dr. S. Barry Eiden

September 26th, 2010 at 5:09 pm    


Ankit:

Yes, I have treated many patients with problems similar to yours. It is unfortunate if the problem is your pupil size since that measure should be taken prior to surgery and if a problem, should have been discussed with you as a possible contraindication for surgery. In any case, there are a number of treatment options for you. First of all, if your vision correction was calculated properly and you do not have a significant refractive error remaining following surgery then your problem may simply be vision distortion secondary to high order aberrations of vision that increase in environments where your pupil dilates greatly. You may benefit from using some form of miotic eye drop. Some people have used low concentrations of pilocarpine, but there may be unacceptable side effects. Additionally, we have had success with the use of Alphagan-P 1%. This is a drug (drop form) that is approved for lowering eye pressure for glaucoma patients, however it also tends to mildly reduce pupil size. We have prescribed this drug to be taken one drop in the late afternoon just prior to darkness with good results and minimal side effects. In terms of contact lens treatment options, the high order aberrations likely are due to corneal changes following your LASIK, and yes a rigid contact lens (scleral or corneal) may significantly “mask” these surface irregularities. In addition, we have fit opaque colored contact lenses (soft) to create an artificially smaller pupile size. This is another option. The key is for you to see someone who is experienced in the management of post LASIK vision complications (contact lens and otherwise). Best of luck to you.

Dr. Eiden

rajesh gupta

January 23rd, 2013 at 3:51 am    


i have post rk complications in my both eye my doctor advised me with Scleral Contact Lenses i wan tto know
where can i get these lens in India

Dr. S. Barry Eiden

March 10th, 2013 at 1:56 pm    


Scleral lenses are a wonderful option for the correction of corneal irregularities of all kinds, including those that happen following refractive surgery complications such as with RK (Radial Keratotomy). Be sure that you eye doctor has significant experience in fittting scleral lenses (ie has fit at least 20 to 50 cases in the past year or so). Scleral lenses are becoming more popular and as such many doctors have “tinkered” with fitting small numbers of patients. The problem is that they don’t have the knowledge or experience to deal with any complications that may happen. One nice resource is the Scleral Lens Society which is made up of practitioners with great interest and experience in fitting scleral lenses. Google them for their website.

Naveen Lobo

May 22nd, 2013 at 9:46 pm    


I am from Mumbai. Had a lasik operation in 2001. All was well
till 2007 December then
eyes started burning, Since 2009 suffering from serious CVS computer
related syndromme.
Tried everything in the books or mentioned you know
20-20-20 every twenty minutes took twenty seconds break blinked 20
times, hot scrubs. Gunnar eye specs, omega 3, eye exercises.
Cyclosporine, artifical drops
Visted many doctors but everybody is saying my eyes are fine but i know that my eyes are not fine

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