|
International Newsletter and Forum on Rigid Gas Permeable Contact Lenses, Corneal Shape, Health and Vision |
|
|
|
|
|
|
Clearance S(c)ale
Vaulting the cornea by creating a certain amount of clearance between the cornea and the back surface of the lens is considered the key element in scleral lens fitting. This bridges the cornea, which prevents any direct pressure on the often delicate corneal surface (in the case of corneal disease) and creates a moist layer of fluid that can provide relief for dry eyes. But how to assess the clearance? Optical coherence tomography is probably the most accurate way of establishing the exact amount of clearance by measuring this (centrally or limbally) in microns. But most practitioners probably rely on their slit lamp examination. Two new educational tools surfaced recently that can be a tremendous help for the (beginning) practitioner. The next item in this newsletter discusses a (free) Scleral Lens Fit Scale from the Michigan College of Optometry. Other useful and free resources are two YouTube videos (initiated by B+L) on central scleral lens clearance and limbal scleral lens clearance. It is good to keep in mind that a recent poster at the Global Specialty Lens Symposium by Debby Yeung and Gina Sorbora of the University of Waterloo (Canada) noted that there was an overall trend to underestimate the clearance by approximately 50µm with the slit lamp technique compared to using an ultrasound technique. This was regardless of prior experience with scleral lens fitting, although the intermediate and the expert groups demonstrated significantly less inter-observer variability. Yet another (free) tip: scleral lenses tend to 'sink' slightly into the conjunctiva after the initial fit, probably in the range of 100-200 microns - hence, some sort of margin needs to be incorporated to allow for this. It is advisable to check the lens after several hours of wear. All in all - it seems we are clearly clearing clearance!
|
Scale to Fit
Josh Lotoczky, Chad Rosen and Craig Norman from the Michigan College of Optometry have developed a scale for scleral lens fitting characteristics. It evaluates the scleral lens edge in relation to the conjunctiva - specifically, conjunctival impingement, absence of that or lens edge lift-off. It also beautifully shows a variance in central clearance behind the lens of 50, 150, 300, 500 and 600 microns, and it subdivides limbal clearance into 'absent,' 'good' and 'moderate.' All clearances are compared to a standard 300-micron center thickness scleral lens. The clinical significance of the amount of clearance in combination with the center thickness of the scleral lens has been demonstrated previously in a paper by Michaud et al in Contact Lens and Anterior Eye. The paper suggests that if the clearance exceeds 200 microns in a 250-micron thickness lens manufactured in a 150-Dk material - in theory, corneal edema could develop. A poster presented at the BCLA 2014 Clinical Conference, 6-9 June 2014 in the UK from Mauro Frisani (Italy) looked that the use of a miniscleral contact lens for five hours of wear. Although they did find corneal thickness changes in subjects with a normal cornea during scleral lens wear, they considered this to be within the normal corneal physiological limits. They compared scleral lens wear to silicone hydrogel soft lens wear using a Scheimpflug camera to measure corneal thickness.
Scleral Lens Fit Scale - Michigan College of Optometry
|
What's on Tap?

Susan Gromacki has been referring to the use of tap water with (R)GP lenses in her columns in Contact Lenses Today recently. Although the U.S. Food and Drug Administration (FDA) contraindicates the practice of using tap water in (R)GP lens care on its website, 15 out of 18 (R)GP lens solutions still allow a tap water rinse as part of their labelled instructions, according to Gromacki. She sought to clarify FDA's perspective, and in a response from the FDA it was stated that: "As noted at the 2014 Panel meeting, there has historically been under-reporting of adverse events of keratitis in rigid gas permeable contact lenses after rinsing with or storing in tap water. When this issue was again raised at the 2014 meeting, it was determined that overwhelming data does not exist at this time to mandate changes. However, while relatively rare, we believe consumers should be made aware of the possibility of infection associated with water; hence, the reason we recommend not exposing contact lenses to water. In the interim, we continue to work with lens manufacturers with respect to developing an alternative to water." See link below for access to the columns mentioned.
Gromacki - Contact Lens Today - Aug 3, 2014
|
A Round of Applause for (R)GPs
Ron Watanabe in Contact Lens Spectrum describes several really interesting cases regarding (R)GP corneal lenses. His case reports describe how (R)GP lenses can provide superior optics, can better correct astigmatism, and they may decrease dryness symptoms that result from surface dehydration of soft lenses. He discusses cases involving 3-9 o'clock staining and lens adherence. He states that "Corneal GP lenses can be a great option for patients desiring excellent visual acuity. In some cases, they can improve comfort when soft lenses seem to dehydrate excessively. Suboptimal fitting can cause complications; if you know how to solve these problems, you can help your patients remain successful." See the full access article with case reports via link below.
|
(R)GP-assisted Cataract Surgery in Severe Keratoconus
During cataract surgery in cases with severe keratoconus, the intraocular images are distorted and the visual perspective is lost because of irregular corneal astigmatism. Poor visibility can lead to complications including posterior capsule rupture and corneal endothelial cell damage. A paper from Japan in Cataract & Refractive Surgery teaches us that (R)GP lenses can assist in these cases. To overcome the problems described, (R)GP lenses were placed on the cornea in two cases that are described in the article. The image distortion decreased markedly, and the visual perspective improved while intraocular manipulations such as irrigation/aspiration were performed safely in the procedure. Improvement in trans-illumination led to good visualization of the anterior and posterior capsules, according to the authors. No intraoperative or postoperative complications developed in either case. Hence, the paper concluded that the technique provided excellent visualization during cataract surgery in patients with severe keratoconus. Photo Jan Pauwels UZA Antwerpen
|
A Very Good First Impression
A 78-year-old white female was referred to our office by her retinal specialist. She'd had extremely poor vision for about 15 years in each eye (20/hand motion), a penetrating keratoplasty ODS, phakic IOL OD, aphakic OS, a bleb with stunt ODS, as well as different forms of macular degeneration ODS. A variety of contact lens options were tried to improve vision, but all failed due to poor fit and lens dislodgement. Scleral lenses would not work due to the large bleb at 2 o'clock. The only option remaining was an impression technique scleral lens, in which a mold of the eye is taken and sent to the lab for fabrication. The EyePrintPRO impression technique system is a transparent scleral cover shell designed to match the exact contours of the cornea and sclera. The patient's vision with this lens returned to 20/50 OU with no over-refraction. For difficult to fit corneas/scleras, the EyePrintPRO can be an amazing option. Because an impression of the ocular surface is taken, it leaves no guesswork when designing a lens. The result is a precise fit and great vision.
|
Upcoming Events
- ECLSO, Oct 10-11, Dubrovnik (KR)
- OSO, Oct 17-19, Gold Coast (AU)
- AAO, Nov 12-15, Denver (US)
- Cornea, CL & Cont. Vision Care Symposium, Dec 6-7, Houston (US)
- Global Specialty Lens Symposium, Jan 22-25, Las Vegas (US)
- CLSS, March 14-15, Billund (Dk)
|
|
|
|
|
|
I-site is an educational newsletter that is distributed on a monthly basis and provides an update on rigid gas permeable related topics (scientific research, case reports and other publications worldwide). I-site is objective and non-political. Its editor Eef van der Worp, optometrist, PhD, FAAO, FBCLA, FIACLE, FSLS is a lecturer for a variety of industry partners, but is not related to any specific company. Please contact us at: i-site@netherlens.com.
|
|
|