Preliminary Clinical Exploration of Scleral Lens Performance on Normal Eyes

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Melissa Barnett
Jonathon Ross
Blythe Durbin-Johnson


scleral lens; scleral contact lens; front-surface toric scleral lens; lens performance; normal eyes; healthy eyes



Objectives: The purpose of this study was to evaluate the performance (i.e. vision, comfort and fit) of spherical and front-surface toric scleral lenses in subjects with regular, healthy corneas.

MethodsScleral lenses were fitin the eyes (n = 16) of healthy subjects (n = 9) with regular corneas, absent of pathology, and studied using an observational, multi-visit design. Lens fit was objectively evaluatedby an experienced practitioner.Following 1 month of successful lens wear, participants completedsubjective satisfaction surveys regarding the scleral lens wearing experience.

Results:  According to participant surveys, scleral lenses were subjectively preferred over soft toric or gas permeable contact lenses in 88% of eyes, including in all eyes fit with a front-surface toric scleral lens (n = 3). Seventy-five percent (75%) of eyes achieved visual acuity of 0.1 logMAR or better, while all eyes with prior spectacle wear achieved visual acuity with a scleral lens within 1 Snellen line of spectacle correction. Seventy-five percent (75%) of eyes achieved good subjective comfort with a scleral lens. No participants reported poor subjective vision and/or comfort.

ConclusionsOur findings suggest that subjects preferred the performance of a scleral lens (spherical or front-surface toric) compared to a soft toric or gas permeable contact lens. Moreover, scleral lenses may provide a viable, alternative contact lens modality option for patients considering discontinuation of traditional soft toric and/or rigid contact lens wear; so long as the factors associated with hypoxia remain minimized.

Key Words:  scleral lens; scleral contact lens; front-surface toric scleral lens; lens performance; normal eyes; healthy eyes

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1. Bowen TJ. Contact Lenses: The Story. Kent: Bower House Publications; 2009.
2. Fick AE. A contact lens. 1888. Arch Ophthalmol 1997;115:120–1.
3. Barnett M, Johns LK. History of Scleral Lenses. In: Contemporary Scleral Lenses: Theory and Application. Bentham Science; 2017. ISBN: 978-1-68108-567-8.
4. Ezekiel D. Gas permeable haptic lenses. J Br Contact Lens Assoc 1983:158–61.
5. Rosenthal P, Cotter J. The Boston Scleral Lens in the management of severe ocular surface disease. Ophthal-mol Clin North Am 2003;16:89–93.
6. Pullum KW, Buckley RJ. A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. Cornea 1997;16:612–22.
7. Schornack MM. Scleral lenses: a literature review. Eye Contact Lens 2015;41:3–11.
8. van der Worp E, Bornman D, Ferreira DL, et al. Modern scleral contact lenses: A review. Cont Lens Anterior Eye 2014;37:240–50.
9. Barnett M, Johns LK. Scleral Lenses for the Regular / Normal / Non-Diseased Cornea. In: Contemporary Scleral Lenses: Theory and Application. Bentham Science;2017:133–4.
10. Nichols JJ, Willcox MD, Bron AJ, et al. The TFOS International Workshop on Contact Lens Discom-fort: executive summary. Invest Ophthalmol Vis Sci 2013;54:TFOS7-TFOS13.
11. Schlanger JL. A study of contact lens failures. J Am Optom Assoc 1993;64:220–4.
12. Weed K, Potvin R. Discontinuation of contact lens wear. Optom Vis Sci 1993;70:140.
13. Pritchard N, Fonn, D, Brazeau D. Discontinuation of contact lens wear: a survey. Intern Contact Lens Clinic 1999;26:157–61.
14. Young G, Veys, J., Pritchard, N., Coleman, S. A multi-centre study of lapsed contact lens wearers. Ophthal Physiol Opt 2002;22:516–27.
15. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea 2007;26:168–74.
16. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 2013;39:93–9.
17. Holden BA. The principles and practice of correcting astimgatism with soft contact lenses. Aust J Optom 1975;58:279–99.
18. Michaud L, Barriault C, Dionne A, Karwatsky P. Empirical fitting of soft or rigid gas-permeable contact lenses for the correction of moderate to severe refractive astigma-tism: a comparative study. Optometry 2009;80:375–83.
19. Lafosse E, Romin DM, Esteve-Taboada JJ, et al. Compari-son of the influence of corneo-scleral and scleral lenses on ocular surface and tear film metrics in a presbyopic population. Cont Lens Anterior Eye 2018;41:122–7.
20. Maeda N. Evaluation of optical quality of corneas using corneal topographers. Cornea 2002;21:S75–8.
21. Roberts B, Athappilly G, Tinio B, et al. Higher order aberrations induced by soft contact lenses in normal eyes with myopia. Eye Contact Lens 2006;32:138–42.
22. Sabesan R, Johns L, Tomashevskaya O, et al. Wavefront-guided scleral lens prosthetic device for keratoconus. Optom Vis Sci 2013;90:314–23.
23. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf 2017;15:802–12. 24. Alipour F, Kheirkhah A, Jabarvand Behrouz M. Use of mini scleral contact lenses in moderate to severe dry
eye. Cont Lens Anterior Eye 2012;35:272–6.
25. Jaynes J, Weissman BA, Edrington T. Predicting scleral
GP lens entrapped tear layer oxygen tensions. Cont Lens Anterior Eye 2015;38:392.
26. Compan V, Oliveira C, Aguilella-Arzo M, et al. Oxygen diffusion and edema with modern scleral rigid gas permeable contact lenses. Invest Ophthalmol Vis Sci 2014;55:6421–9.
27. Compan V, Aguilella-Arzo M, Edrington TB, Weiss-man BA. Modeling corneal oxygen with scleral gas permeable lens wear. Optom Vis Sci 2016;93:1339–48.
28. Paugh JR, Chen E, Heinrich C, et al. Silicone hydrogel and rigid gas-permeable scleral lens tear exchange. Eye Contact Lens 2018;44:97–101.
29. Michaud L, van der Worp E, Brazeau D, et al. Predicting estimates of oxygen transmissibility for scleral lenses. Cont Lens Anterior Eye 2012;35:266–71.
30. Bergmanson JP, Ezekiel DF, van der Worp E. Scleral contact lenses and hypoxia: Theory versus practice. Cont Lens Anterior Eye 2015;38:145–7.
31. Vincent SJ, Alonso-Caneiro D, Collins MJ, et al. Hypoxic corneal changes following eight hours of scleral contact lens wear. Optom Vis Sci 2016;93:293–9.
32. Giasson CJ, Morency J, Melillo M, Michaud L. Oxygen tension beneath scleral lenses of different clearances. Optom Vis Sci 2017;94:466–75.
33. Fadel D. Modern scleral lenses: Mini versus large. Cont Lens Anterior Eye 2017;40:200–7.
34. Turpin S, Caroline P, Kojima R, et al. Does IOP Increase During Scleral Lens Wear? In: Global Specialty Lens Symposium (GSLS). Las Vegas, NV; 2018.
35. Nau CB, Schornack MM, McLaren JW, Sit AJ. Intraocu-lar pressure after 2 hours of small-diameter scleral lens wear. Eye Contact Lens 2016;42:350–3.
36. Vincent SJ, Alonso-Caneiro D, Collins MJ. Evidence on scleral contact lenses and intraocular pressure. Clin Exp Optom 2017;100:87–8.
37. Alonso-Caneiro D, Vincent SJ, Collins MJ. Morphological changes in the conjunctiva, episclera and sclera following short-term miniscleral contact lens wear in rigid lens neophytes. Cont Lens Anterior Eye 2016;39:53–61.