Although (R)GP corneal lenses remain a viable contact lens option that we certainly should not forget about, scleral lenses have been getting most of the attention lately - as was evident at the recent 2014 Global Specialty Lens Symposium (GSLS) in Las Vegas. Actually, custom-made soft lenses are on the rise as well (see soft-special-edition newsletter for a quarterly newsletter on that topic), but scleral lenses dominated the GSLS program. Although the I-site newsletter tries to cover everything - from orthokeratology to cosmetic (R)GP lens fitting and managing the irregular cornea - the topics in this edition happened, almost by coincidence, to be predominantly scleral lens-related - also showing the gradual process of 'growing up,' with coverage of the 'standard of care' for scleral lenses and an item on multifocal scleral lenses. Much attention at GSLS was devoted to the non-rotationally symmetrical nature of the limbus and anterior sclera - and the potential need for non-rotationally symmetrical lenses (like toric, or more complex shapes). A new impression technique was also introduced, eye print prosthetic, where the created cast is scanned and a custom-made lens in any given material can be made on a lathe. On the other hand: many questions remained unanswered regarding sclerals like: how much oxygen is needed for the cornea in scleral lens wear and what is the 'milky stuff' behind the scleral lens: is it lipids or protein? Stay tuned! Hopefully we will find the answers to questions like these soon, as many groups around the world are working on this

Graft rejection fortunately is not that common, but what can we do post-PKP with our lens care to minimize the chances of complications? On one hand, creating sufficient clearance is mandatory to prevent mechanical contact with the cornea, especially at the transition from host to donor cornea, and to allow space for a potentical recurrence of the ectasia in the host tissue. On the other hand - reduced clearance may contribute to a better oxygen supply to the cornea, in theory at least. Boris Severinsky et al from Israel in a paper in Contact Lens & Anterior Eye looked at 33 PKP patients, their complication rate and their success. The average wearing time of the large diameter scleral lenses was 11.8 hours per day. The authors suggest to advise the graft patients to take breaks during contact lens wear to minimize toxicity damage. 

Severinsky et al - Contact Lens & Ant Eye, Dec 2013