Fully scleral contact lenses are a good option for achieving successful visual rehabilitation in irregular corneas.
Two subgroups were distinguished in scleral lenses depending on the presence of corneal bearing or not: corneo-scleral or semi-scleral. Recently, the Scleral Lens Education Society (SLS) has defined a more precise differentiation between different modalities of scleral lenses not only based on the lens diameter, but also on the diameter of visible iris of the eye in which the lens is fitted, as detailed in Table 1.1.
SLS supports public education that highlights the benefits and availability of scleral contact lenses.
Researchers found that fully scleral lens of a specific diameter can behave as miniscleral or large-scleral, depending upon the eye on which it is fitted.
This type of lens must always be inserted after being completely filled with saline solution, avoiding the formation of bubbles during the insertion that ultimately could lead to discomfort and poor vision in the patient.
Scleral contact lenses have always been considered suitable for the correction of irregular astigmatism (post-corneal refractive surgery,2,3 post-keratoplasty4–6), including keratoconus7-12 and other ectatic disorders,13 as they are able to neutralize irregularities with the tear film meniscus that form with the cornea, while maintaining high levels of comfort.
However, there are also other indications feasible for corneo-scleral and fully scleral contact lenses, such as the correction of refractive errors that cannot be corrected satisfactorily with rigid gas-permeable (RGP) corneal or soft contact lenses, the introduction of prismatic corrections, for cosmetic purposes and even in healthy corneas, due to the advantages of this type of lens: less palpebral interaction, great comfort as conjuntictival sensitivity is lower than that of the cornea, no possibility of generating corneal distortion if the fitting is adequate and a simplified fitting process.14
In addition, the process of insertion and removal of the lens is simplified by the use of a suction cup, avoiding the contact of the fingers with the eye at all times.
David P. Piñero Llorens, PhD
E: [email protected]
Dr. Piñero Llorens is researcher/lecturer, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain and Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain.
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