Compliance Using Scleral Lenses

Main Article Content

Daddi Fadel
Mindy Toabe


scleral contact lens, microbial keratitis, hygiene


The rise in scleral contact lens (ScCL) use may increase the risk of complications including microbial keratitis. Patient understanding of hygiene as well as care and handling of ScCLs is crucial to prevent the increase of complications.

This manuscript presents a review of the modalities and implications of the hygiene and the care of scleral lenses, storage case, and devices. Also, correct application and removal techniques are explained in detail and recommendations on instructions for ScCL wearers and verification of patient compliance are provided.

Adverse events are rarely reported in literature but clinicians need to understand how to deliver appropriate information and instruction regarding basic rules of hygiene, contact lens care and handling to patients to prevent and minimize associated infections. It is fundamental that practitioners learn how to impart knowledge to their patients during every encounter including follow up visits regarding proper management and compliance with ScCLs. Also, a dialogue with the patient is essential to develop empathy allowing for greater collaboration and compliance raising the fitting rate, success and patient’s overall satisfaction.

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1. Ruben CM, Benjamin WJ. Scleral contact lenses: preliminary report on oxygen permeable materials. Contact Lens J 1985;13:5–10.
2. Bleshoy H, Pullum KW. Corneal response to gas permeable impression scleral lenses. J Br Contact Lens Assoc 1988;11:31–4.
3. Pullum KW, Hobley A. Parker JH. The Josef Dallos Award Lecture, part two. Hypoxic corneal changes following sealed gas permeable impression scleral lens wear. J Br Contact Lens Assoc 1990;13:83–7.
4. Pullum KW, Hobley AJ, Davison C. 100+ Dk: does thickness make much difference? J Br Contact Lens Assoc 1991;6:158–61.
5. Mountford J, Carkeet N, Carney L. Corneal thickness changes during scleral lens wear: effect of gas permeability. International Contact Lens Clinic 1994;21(1-2):19–22. doi: 10.1016/0892-8967(94)90036-1
6. Zimmerman AB, Marks A. Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. Eye Contact Lens 2014;40:e1–e4. doi: 10.1097/ ICL.0b013e318273420f
7. Walker M, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and rifitting challenges associated with scleral contact lenses: A review. Cont Lens Anterior Eye 2016;39:88–96. doi: 10.1016/j.clae.2015.08.003
8. Rosenthal P, Cotter JM, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. Am J Ophthalmol 2000;130:33–41. doi: 10.1016/S0002-9394(00) 00379-2.
9. Kalwerisky K, Davies B, Mihora L, Czyz CN, Foster JA, Demartelaere S. Use of the Boston ocular surface prosthesis in the management of severe periorbital thermal injuries: a case series of 10 patients, Ophthalmology 2012;119:516–21. doi: 10.1016/j.ophtha.2011.08.027.
10. Severinsky B, Behrman S, Frucht-Pery J, Solomon A. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes, Cont Lens Anterior Eye 2014;37:196–202. doi: 10.1016/j. clae.2013.11.001.
11. Fernandes M, Sharma S, Polymicrobial and microsporidial keratitis in a patient using Boston scleral contact lens for Sjogren’s syndrome and ocular cicatricial pemphigoid, Cont Lens Anterior Eye 2013;36:95–97. doi: 10.1016/j.clae.2012.10.082.
12. Farhat B, Sutphin JE. Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens, Eye Contact Lens 2014;40:e5–7. doi: 10.1097/ICL.0b013e3182997c4c.
13. Schornack M. Scleral lenses in current ophthalmic practice evaluation: SCOPE study updates. Presentation at the Global Specialty Lens Symposium. Las Vegas, 2017 January, 26-29.
14. U.S. Centers for Disease Control and Prevention. Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers – Talking Points April 20, 2016.
15. Sauer A, Meyer N, Bourcier T. Risk factors for contact lens-related microbial keratitis: a case–control multicenter study. Eye Contact Lens 2016;42:158–62. doi: 10.1097/ICL.0000000000000180.
16. Szczotka-Flynn LB, Imamura Y, Chandra J, Yu C, Mukherjee PK, Pearlman E, Ghannoum MA. Increased resistance of contact lens related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea 2009;28(8):918–26. doi: 10.1097/ICO.0b013e3181a81835.
17. Cope JR, Collier SA, Schein OD, Brown AC, Verani JR, Gallen R, Beach MJ, Yoder JS. Acanthamoeba keratitis among rigid gas permeable contact lens wearers in the United States, 2005 through 2011. Ophthalmology 2016;123(7):1435–41. doi: 10.1016/j.ophtha.2016.03.039.
18. Bruce, AS., Nguyen, LM. Acute red eye (non-ulcerative keratitis) associated with mini-scleral contact lens wear for keratoconus. Clin Exp Optom 2013;96:(2):245–8. doi:10.1111/cxo.12033
19. Rocha, GA., Miziara, PO., Castro AC., Rocha AA. Visual rehabilitatiaon using mini-scleral contact lenses after penetrating keratoplasty. Arq Bras Ofthalmo 2017;80(1):17–20. doi: 10.5935/0004-2749.20170006.
20. Morgan PB. Contact lens compliance and reducing the risk of keratitis. The Optician 2007;20–25.
21. Sokol JL, Mier MG, Bloom S, Asbell PA. A study of patient compliance in a contact lens-wearing population. CLAO 1990;J16(3):209–13.
22. Bowden T, Harknett T. Contact lens wearer profile 2004. Cont Lens Anterior Eye 2005;28:37–45. doi: 10.1016/j.clae.2004.10.002
23. Claydon BE, Efron N. Non-compliance in contact lens wear. Ophthal Physiol Opt 1994;14:356–64.
24. Friedman DS, Hahn SR, Quigley HA, Kotak S, Kim E, Onofrey M, Eagan C, Mardekian J. Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. Ophthalmology 2009;116. 2277-2285.e1-3. doi: 10.1016/j.ophtha.2009.04.052
25. Campbell D, Mann A, Hunt O, Santos LJR. The significance of hand wash compliance on the transfer of dermal lipids in contact lens wear. Cont Lens Anterior Eye 2012;35:71–76; quiz 96–7. doi: 10.1016/j.clae.2011.11.004. Epub 2011 Dec 16.
26. Ousler GW, Michaelson C, Christensen MT. An evaluation of tear film breakup time extension and ocular protection index scores among three marketed lubricant eye drops. Cornea 2007;26:949–52. doi: 10.1097/ICO.0b013e3180de1c38
27. Fonn D. The clinical relevance of contact lens lubricity. Contact Len Spectrum 2013;28:25–27.
28. Jones L, Brennan NA, Gonzalez-Meijome J, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the Contact Lens Materials, Design, and Care Subcommittee. Invest Ophthalmol Vis Sci 2013;54 (11) : TFOS37-70). doi: 10.1167/iovs.13-13215
29. Caroline, P. et al. Hydra-PEG: A Solution to Contact Lens Discomfort? Poster presented at Global Specialty Lens Symposium 2015.
30. Sindt CW. The great silicone cover-up. Rev Cornea Cont Lens 2015;4:7.
31. Sindt CW. Tangible Hydra-PEG: A novel custom contact lens coating technology designed to improve patient comfort and satisfaction. Available at :
32. Lupelli L. Il contenitore: il brutto anatroccolo della contattologia. LAC 2010;12:3–6.
33. Wu, Y, Willcox M, Stapleton F. The effect of contact lens hygiene behavior on lens case contamination. Optom Vis Sci 2015;92(2):167–74. doi: 10.1097/OPX.0000000000000477.
34. Wiley L, Bridge DR, Wiley LA, Odom JV, Elliott T, Olson JC. Bacterial biofilm diversity in contact lens-related disease: emerging role of Achromobacter, Stenotrophomonas, and Delftia. Invest Ophthalmol Vis Sci 2012;53(7):3896–905. doi: 10.1167/iovs.11-8762.
35. Bates AK, Morris RJ, Stapleton F, Minassian DC, Dart JK. ‘Sterile’ corneal infiltrates in contact lens wearers. Eye 1989;3(Pt. 6):803–10. doi: 10.1038/eye.1989.124
36. Willcox MD. Solutions for care of silicone hydrogel lenses. Eye Contact Lens 2013;39(1):24–8. doi: 10.1097/ICL.0b013e318275e0d9.
37. Wu YT, Zhu H, Willcox M, Stapleton F. The effectiveness of various cleaning regimens and current guidelines in contact lens case biofilm removal. Invest Ophthalmol Vis Sci 2011;52(8):5287–92. doi: 10.1167/iovs.10-6785.
38. Wu YT, Teng YJ, Nicholas M, Harmis N, Zhu H, Willcox MD, Stapleton F. Impact of lens case hygiene guidelines on contact lens case contamination. Optom Vis Sci 2011;88(10)1180–7. doi: 10.1097/OPX.0b013e3182282f28.
39. Sweeney D, Holden B, Evans K et al. Best practice contact lens care; a review of the Asia Pacific Contact Lens Care Summit. Clin Exp Optom 2009;92(2):78–89. doi: 10.1111/j.1444-0938.2009.00353.x.
40. FDA. Ensuring safe use of contact lens solution. 2017. Available at:
41. Wu Y, Carnt N, Willcox M, Stapleton F. Contact lens and lens storage case cleaning instructions: whose advice should we follow? Eye Contact Lens 2010;36(2):68–72. doi: 10.1097/ICL.0b013e3181cf8aff.
42. American Optometric Association. Contact Lens Care and Use. 2017. Available at:
43. Sticca M, Carvalho C, Silva I, Souza L, Belfort R, Carvalho R, Freitas D. Acanthamoeba keratitis in patients wearing scleral contact lenses. Con Lens Ant Eye; 2017. Available at:
44. Hickson-Curran S, Chalmer RL. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye 2011;34(5):207–15. Epub 2011 Jan 11. doi: 10.1016/j.clae.2010.12.005.
45. Tilia D, Lazonde la Jara P, Zhu H. The effect of compliance on contact lens case contamination. Optom Vis Sci 2014;91(3):262–71. doi: 10.1097/OPX.0000000000000163.
46. Morgan PB, Efron N, Toshida H., Nichols JJ. An international analysis of contact lens compliance. Cont Lens Anterior Eye 2011;34(5):223–28. Epub 2011 Aug 24. doi: 10.1016/j.clae.2011.08.001.