Basics of Scleral Lenses and First Lens Selection by Dr. Daddi Fadel

November 21, 2020
| No Comments
Online Optom Learning Series (OOLS) Sessions

Dr. Daddi Fadel, a practicing optometrist and a contact lens expert begins by defining the scleral lens, stating it’s advantages and contraindications. She dives straight into explaining the three step scleral lens fitting process.

  1. Patient selection 
    1. No age limit 
    2. Anomalies of corneal endothelium 
    3. Diabetic or immunocompromised patients 
    4. Glaucoma 
    5. Sports contraindications 
    6. Ocular Examination 
  2. Trial lens selection 
    1. Diameter 
    2. Lens sagittal height 
  3. Observation Center corneal clearance 
    1. Peripheral corneal clearance 
    2. Limbal clearance 
    3. Blanching vs indentation 
    4. Scleral toricity 
    5. Edge fitting 

Dr. Fadel shows us the different pattern that we may see on fitting spherical scleral lenses on a toric sclera. We also discuss ordering the lens and the schedule for re-assessment of the lens fit. Lastly, we learn some tips and tricks of fitting scleral lenses

  1. Air Bubbles
  2. Lens application techniques and devices 
  3. Lens removal techniques and devices 
  4. Debris or Midday fogging 
  5. Poor wettability 
  6. Light and observation when assessing the lens 
  7. Empathetic Communication 

We conclude the session with some resources available for the audience. The session ends with a Q and A section for the live audience.

References

Papers

Fadel D, Kramer E. Potential contraindications to scleral lens wear. Cont Lens Anterior Eye. 2019 Feb;42(1):92-103.

https://pubmed.ncbi.nlm.nih.gov/30392894/

Picot C, Gauthier AS, Campolmi N, Delbosc B. Qualité de vie des patients équipés en verres scléraux [Quality of life in patients wearing scleral lenses]. J Fr Ophtalmol. 2015 Sep;38(7):615-9.

https://pubmed.ncbi.nlm.nih.gov/26001955/

Koppen C, Kreps EO, Anthonissen L, Van Hoey M, Dhubhghaill SN, Vermeulen L. Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus. Am J Ophthalmol. 2018 Jan;185:43-47.

https://pubmed.ncbi.nlm.nih.gov/29103959/

Kornberg DL, Dou E, Wang Y, St Clair R, Lee MN, Sood P, Fernandez AA, Ciralsky JB, Sippel KC, Rosenblatt MI. Clinical Experience With PROSE Fitting: Significance of Diagnosis and Age. Eye Contact Lens. 2016 Mar;42(2):124-8.

https://pubmed.ncbi.nlm.nih.gov/26020485/

O’Donnell C, Efron N. Corneal endothelial cell morphometry and corneal thickness in diabetic contact lens wearers. Optom Vis Sci. 2004 Nov;81(11):858-62.

https://pubmed.ncbi.nlm.nih.gov/15545812/

Editorials

Contact Lens Spectrum – Scleral lenses: Prepare for landing. Fadel, D.

https://www.clspectrum.com/issues/2017/august-2017/scleral-lenses-prepare-for-landing

Contact Lens