Scleral Lens Issues and Complications Related to Handling, Care and Compliance
Main Article Content
Abstract
Scleral contact lens (ScCL) handling may be challenging and is the principle reason for ScCL drop out. ScCL care systems are more intricate than other lens modalities and include solutions for cleaning, disinfection, storing, rinsing and filling the lens; respecting the use of each solution recommended is fundamental. Replacement of the lenses, solutions, case and plungers are important in order to decrease the risk of adverse events associated with ScCL wear. Compliance is crucial regarding hygiene, solution use, case and plunger care, wear time, follow-up schedule, and handling techniques. Non-compliance may lead to discontinuation of ScCL due to difficulties associated with this unique lens design.
This paper presents complications secondary to handling, care and compliance that clinicians and patients may encounter while wearing ScCL. Instructions are provided to enhance the understanding on management surrounding these issues. This manuscript includes three tables to summarize types of complications, their symptoms, clinical signs, etiology, and management for a quick find index for easy consultation during daily clinical practice.
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1.
Fadel D, Toabe M. Scleral Lens Issues and Complications Related to Handling, Care and Compliance. JCLRS [Internet]. 2018Oct.26 [cited 2024Apr.24];2(2):e1-e13. Available from: http://www.jclrs.org/index.php/JCLRS/article/view/24
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Review Article
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References
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8. Papkostas T, Le H, Chodosh J, Jacobs D. Prosthetic replacement of the ocular surface ecosystem as treatment for ocular surface disease in patients with a history of Stevens-Johnson syndrome/toxic epidermal necrolysis. Ophthamology 2015;Feb;122(2):248–53. doi: 10.1016/j.ophtha.2014.08.015. Epub 2014 Oct 1.
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10. Suarez C, Madariaga V, Lepage B, et al. First experience with the icd 16.5 mini-scleral lens for optic and therapeutic purposes. Eye Contact Lens. 2018 Jan;44(1):44–9. doi: 10.1097/ICL.0000000000000293.
11. Romero-Rangel T, Stavrou O, Cotter J, et al. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthal 2000 Jul;130(1):25–32.
12. Kornberg D, Dou E, Wang Y, et al. Clinical experience with prose fitting: significance of diagnosis and age. Eye Contact Lens 2016 Mar;42(2):124–8. doi: 10.1097/ICL.0000000000000151.
13. Bavinger J, DeLoss K, Mian S. Scleral lens use in dry eye syndrome. Curr Opin Ophthalmol 2015 Jul;26(4):319–24. doi: 10.1097/ICU.0000000000000171.
14. Zimmerman AB, Marks A. Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. Eye Contact Lens 2014 Jan;40(1):e1–4. doi: 10.1097/ICL.0b013e318273420f.
15. Severinsky B, Behrman S, Frucht-Pery J, Solomon A. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes, Contact Lens Anterior Eye 2014 Jun;37(3):196–202. doi: 10.1016/j.clae.2013.11.001. Epub 2013 Dec 2.
16. Bruce AS, Nguyen LM. Acute red eye (non-ulcerative keratitis) associated with mini-scleral contact lens wear for keratoconus. Clin Exp Optom. 2013 Mar;96(2):245–8. doi: 10.1111/cxo.12033. Epub 2013 Feb 6.
17. Rocha GA, Miziara PO, Castro AC, Rocha AA. Visual rehabilitatiaon using mini-scleral contact lenses after penetrating keratoplasty. Arq Bras Ofthalmol 2017 Jan-Feb;80(1):17–20. doi: 10.5935/0004-2749.20170006.
18. van der Worp E. A Guide to Scleral Lens Fitting, Version 2.0 [monograph online]. Forest Grove, OR: Pacific University; 2015. Available from: http://commons.pacificu.edu/mono/10/.
19. Barnett M, Fadel D. Benefits of toric sclerals. Contact Lens Spectrum 2017 Nov;32:36–41.
20. Miller WL. Managing scleral-lens induced conjunctival prolapse complications. Contact Lens Spectrum 2015;Sep;30:48.
21. Luensmann, D, Moezzi, A, Peterson RC, Woods, C, and Fonn D. Corneal staining and cell shedding during the development of solution-induced corneal staining. Optom Vis Sci 2012 Jun;89(6):868–74.
22. Caroline PJ, Andre MP. “Life” beneath a scleral lens epithelial bogging. Contact Lens Spectrum 2015 Mar;30:56.
23. Ortenberg, I. Wearing time as a measure of success of scleral lenses for patients with irregular astigmatism. Eye & Contact Lens 2013;39(6):381
24. B. Holden. A report card on hydrogen peroxide for contact lens disinfection. Contact Lens Anterior Eye 1990;16:S61–S64.
25. Bruinsma GM, Rustema-Abbing M, de Vries J, et al. Multiple surface properties of worn RGP lenses and adhesion of Pseudomonas aeruginosa. Biomaterial 2003 April;24(9):1663–70.
26. Sticca M, Carvalho C, Silva I, et al. Acanthamoeba keratitis in patients wearing scleral contact lenses. Contact Lens Anterior Eye 2018 Jun;41(3):307–10. doi: 10.1016/j.clae.2017.12.004. Epub 2017 Dec 6.
27. Siergey JL. Troubleshooting nonwetting scleral lenses. https://collaborativeeye.com/articles/mar-apr-18/troubleshooting-nonwetting-scleral-lenses/ Access date April 13, 2018.
28. Lin MC, Svitova TF. Contact lenses wettability in vitro: Effect of surface-active ingredients. Optom Vis Sci 2010 Jun;87(6):440–7. doi: 10.1097/OPX.0b013e3181dc9a1a.
29. Maldonado-Codina C, Morgan PB. In vitro water wettability of silicone hydrogel contact lenses determined using the sessile drop and captive bubble techniques. J Biomed Mater Res A 2007 Nov;83(2):496–502.
30. Tonge S, Jones L, Goodall S, Tighe B. The ex vivo wettability of soft contact lenses. Curr Eye Res 2001 Jul;23(1):51–9.
31. Bennett ES. How important are lens oxygen ratings? They are one of many performance factors.Cornea. 1990;9 Suppl 1:S4–7; discussion S8.
32. Papas EB, Ciolino JB, Jacobs D, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the management and therapy subcommittee. Invest Ophthalmol Vis Sci 2013 Oct 18;54(11):TFOS183–203. doi: 10.1167/iovs.13-13166.
33. Bourassa S, Benjamin WJ. RGP wettability: the first day could be the worst day. International Contact Lens Clinic 1992;19:25–34. https://doi.org/10.1016/0892-8967(92)90029-D
34. Woods C, Efron N. The parameter stability of high dk rigid lens material. Contact Lens Anterior Eye 1999;22(1):14–8.
35. Mahadevan R, Fathima A, Rajan R, Arumugam AO. An ocular surface prosthesis for keratoglobus and Terrien marginal degeneration. Optom Vis Sci 2014 Apr;91(4 Suppl 1):S34–9. doi: 10.1097/OPX.0000000000000200.
36. Michaud L. GPLISLS Scleral lens troubleshooting FAQs. Available from http://gpli.info/pdf/GPLISLSTSGuide11017.pdf Access date April 13, 2018.
37. 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 Jul;130(1):33–41.
38. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens 2005;31(3):130–4.
39. Farhat B, Sutphin J. Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens. Eye Contact Lens 2014 Jan;40(1):e5–7. doi: 10.1097/ICL.0b013e3182997c4c.
40. Walker MK, Bergmanson JP, Miller WL, et al. Complications and fitting challenges associated with scleral lenses: A review. Contact Lens Anterior Eye 2016 Apr;39(2):88–96. doi: 10.1016/j.clae.2015.08.003. Epub 2015 Sep 2.
41. Tan D, Pullum K, Buckley R. Medical applications of scleral contact lenses: 2. gas-permeable scleral contact lenses. Cornea. 1995 Mar;14(2):130–7.
42. Efron N. Papillary conjunctivitis, in Contact Lens Complications. third ed., Elsevier/Saunders, Edinburgh; 2012.
2. Barnett M, Lien V, Li JY, et al. Use of scleral lenses and miniscleral lenses after penetrating keratoplasty. Eye Contact Lens 2016 May;42(3):185–9. doi: 10.1097/ICL.0000000000000163.
3. Asena L, Altinors D. Clinical outcomes of scleral Misa lenses for visual rehabilitation in patients with pellucid marginal degeneration. Contact Lens Anterior Eye 2016 Dec;39(6):420–4. doi: 10.1016/j.clae.2016.06.010. Epub 2016 Jul 16.
4. Pecego M, Barnett M, Mannis MJ, Durbin-Johnson B. Jupiter scleral lenses: the UC Davis Eye Center Experience. Eye Contact Lens 2012 May;38(3):179–82. doi: 10.1097/ICL.0b013e31824daa5e.
5. Koppen C, Kreps E, Anthonissen L, et al. Scleral lenses reduce the need for corneal transplants in severe keratoconus. Am J Ophtalmol 2018 Jan;185:43–7. doi: 10.1016/j.ajo.2017.10.022. Epub 2017 Nov 16.
6. Agranat J, Kitos N, Jacobs D. Prosthetic replacement of the ocular surface ecosystem: impact at 5 years. Br J Ophthalmol. 2016 Sep;100(9):1171–5. doi: 10.1136/bjophthalmol-2015-307483. Epub 2015 Dec 7.
7. Alipour F, Beriuz M, Samet B. Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Contact Lens Anterior Eye 2015 Feb;38(1):54–8. doi: 10.1016/j.clae.2014.10.001. Epub 2014 Oct 25.
8. Papkostas T, Le H, Chodosh J, Jacobs D. Prosthetic replacement of the ocular surface ecosystem as treatment for ocular surface disease in patients with a history of Stevens-Johnson syndrome/toxic epidermal necrolysis. Ophthamology 2015;Feb;122(2):248–53. doi: 10.1016/j.ophtha.2014.08.015. Epub 2014 Oct 1.
9. Rathi V, Dumpati S, Mandathara P, et al. Scleral contact lens I the management of pellucid marginal degeneration. Contact Lens Anterior Eye. 2016 Jun;39(3):217–20. doi: 10.1016/j.clae.2015.11.005. Epub 2015 Dec 3.
10. Suarez C, Madariaga V, Lepage B, et al. First experience with the icd 16.5 mini-scleral lens for optic and therapeutic purposes. Eye Contact Lens. 2018 Jan;44(1):44–9. doi: 10.1097/ICL.0000000000000293.
11. Romero-Rangel T, Stavrou O, Cotter J, et al. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthal 2000 Jul;130(1):25–32.
12. Kornberg D, Dou E, Wang Y, et al. Clinical experience with prose fitting: significance of diagnosis and age. Eye Contact Lens 2016 Mar;42(2):124–8. doi: 10.1097/ICL.0000000000000151.
13. Bavinger J, DeLoss K, Mian S. Scleral lens use in dry eye syndrome. Curr Opin Ophthalmol 2015 Jul;26(4):319–24. doi: 10.1097/ICU.0000000000000171.
14. Zimmerman AB, Marks A. Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. Eye Contact Lens 2014 Jan;40(1):e1–4. doi: 10.1097/ICL.0b013e318273420f.
15. Severinsky B, Behrman S, Frucht-Pery J, Solomon A. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes, Contact Lens Anterior Eye 2014 Jun;37(3):196–202. doi: 10.1016/j.clae.2013.11.001. Epub 2013 Dec 2.
16. Bruce AS, Nguyen LM. Acute red eye (non-ulcerative keratitis) associated with mini-scleral contact lens wear for keratoconus. Clin Exp Optom. 2013 Mar;96(2):245–8. doi: 10.1111/cxo.12033. Epub 2013 Feb 6.
17. Rocha GA, Miziara PO, Castro AC, Rocha AA. Visual rehabilitatiaon using mini-scleral contact lenses after penetrating keratoplasty. Arq Bras Ofthalmol 2017 Jan-Feb;80(1):17–20. doi: 10.5935/0004-2749.20170006.
18. van der Worp E. A Guide to Scleral Lens Fitting, Version 2.0 [monograph online]. Forest Grove, OR: Pacific University; 2015. Available from: http://commons.pacificu.edu/mono/10/.
19. Barnett M, Fadel D. Benefits of toric sclerals. Contact Lens Spectrum 2017 Nov;32:36–41.
20. Miller WL. Managing scleral-lens induced conjunctival prolapse complications. Contact Lens Spectrum 2015;Sep;30:48.
21. Luensmann, D, Moezzi, A, Peterson RC, Woods, C, and Fonn D. Corneal staining and cell shedding during the development of solution-induced corneal staining. Optom Vis Sci 2012 Jun;89(6):868–74.
22. Caroline PJ, Andre MP. “Life” beneath a scleral lens epithelial bogging. Contact Lens Spectrum 2015 Mar;30:56.
23. Ortenberg, I. Wearing time as a measure of success of scleral lenses for patients with irregular astigmatism. Eye & Contact Lens 2013;39(6):381
24. B. Holden. A report card on hydrogen peroxide for contact lens disinfection. Contact Lens Anterior Eye 1990;16:S61–S64.
25. Bruinsma GM, Rustema-Abbing M, de Vries J, et al. Multiple surface properties of worn RGP lenses and adhesion of Pseudomonas aeruginosa. Biomaterial 2003 April;24(9):1663–70.
26. Sticca M, Carvalho C, Silva I, et al. Acanthamoeba keratitis in patients wearing scleral contact lenses. Contact Lens Anterior Eye 2018 Jun;41(3):307–10. doi: 10.1016/j.clae.2017.12.004. Epub 2017 Dec 6.
27. Siergey JL. Troubleshooting nonwetting scleral lenses. https://collaborativeeye.com/articles/mar-apr-18/troubleshooting-nonwetting-scleral-lenses/ Access date April 13, 2018.
28. Lin MC, Svitova TF. Contact lenses wettability in vitro: Effect of surface-active ingredients. Optom Vis Sci 2010 Jun;87(6):440–7. doi: 10.1097/OPX.0b013e3181dc9a1a.
29. Maldonado-Codina C, Morgan PB. In vitro water wettability of silicone hydrogel contact lenses determined using the sessile drop and captive bubble techniques. J Biomed Mater Res A 2007 Nov;83(2):496–502.
30. Tonge S, Jones L, Goodall S, Tighe B. The ex vivo wettability of soft contact lenses. Curr Eye Res 2001 Jul;23(1):51–9.
31. Bennett ES. How important are lens oxygen ratings? They are one of many performance factors.Cornea. 1990;9 Suppl 1:S4–7; discussion S8.
32. Papas EB, Ciolino JB, Jacobs D, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the management and therapy subcommittee. Invest Ophthalmol Vis Sci 2013 Oct 18;54(11):TFOS183–203. doi: 10.1167/iovs.13-13166.
33. Bourassa S, Benjamin WJ. RGP wettability: the first day could be the worst day. International Contact Lens Clinic 1992;19:25–34. https://doi.org/10.1016/0892-8967(92)90029-D
34. Woods C, Efron N. The parameter stability of high dk rigid lens material. Contact Lens Anterior Eye 1999;22(1):14–8.
35. Mahadevan R, Fathima A, Rajan R, Arumugam AO. An ocular surface prosthesis for keratoglobus and Terrien marginal degeneration. Optom Vis Sci 2014 Apr;91(4 Suppl 1):S34–9. doi: 10.1097/OPX.0000000000000200.
36. Michaud L. GPLISLS Scleral lens troubleshooting FAQs. Available from http://gpli.info/pdf/GPLISLSTSGuide11017.pdf Access date April 13, 2018.
37. 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 Jul;130(1):33–41.
38. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens 2005;31(3):130–4.
39. Farhat B, Sutphin J. Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens. Eye Contact Lens 2014 Jan;40(1):e5–7. doi: 10.1097/ICL.0b013e3182997c4c.
40. Walker MK, Bergmanson JP, Miller WL, et al. Complications and fitting challenges associated with scleral lenses: A review. Contact Lens Anterior Eye 2016 Apr;39(2):88–96. doi: 10.1016/j.clae.2015.08.003. Epub 2015 Sep 2.
41. Tan D, Pullum K, Buckley R. Medical applications of scleral contact lenses: 2. gas-permeable scleral contact lenses. Cornea. 1995 Mar;14(2):130–7.
42. Efron N. Papillary conjunctivitis, in Contact Lens Complications. third ed., Elsevier/Saunders, Edinburgh; 2012.