Léonard Kollros is the lead Optometrist at the ELZA Institute, and this month, a paper he authored was published in the Journal Français d’Ophtalmologie. It reports on the use of scleral contact lenses as a treatment option for patients with advanced keratoconus.
KC is a corneal ectasia – a disease that progressively thins, weakens, and steepens the cornea, and this can make it difficult to get traditional rigid CLs to fit properly (and improve visual acuity). Scleral CLs provide a solution to this problem as they rest solely on the sclera, the white part of the eye, instead of the cornea. Indeed, scleral CLs do not touch the cornea at all, with the space between the lens and the cornea being filled with saline fluid. This means not only that small irregularities in the corneal surface can get “filled” with unpreserved saline fluid, improving the irregular astigmatism aspect of keratoconus, but also that the scleral lens fits more securely and is more stable than a rigid lens. Additionally, advances in the geometry and manufacturing of scleral and mini-scleral CLs now allow for the production of lenses with high “Dk” materials, which enable more oxygen to reach the cornea and allow the lenses to be worn for a longer period.
The article suggests that custom scleral CLs should be tried before proceeding to any type of corneal transplantation surgery, as these lenses can significantly improve vision and patients’ quality of life, in many cases, to a point where this form of surgery can be postponed or avoided. This has the advantage of avoiding exposing these patients to the risks associated with this surgical procedure.
Importantly, scleral lenses need to be fitted to each patient’s cornea, so the measurements made of the eye, plus the specifications of the lens to be made must be correct. This can be challenging, and a poorly fitting scleral lens can potentially rub against the cornea if its depth is too shallow, causing discomfort and potential damage to the cornea. Fortunately, as the ELZA Institute are keratoconus experts, we have many years of experience in measuring corneas with keratoconus, and successfully fitting scleral lenses to each patient’s cornea.
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