1 / 21

Understanding Scleral Lenses: A Comprehensive Guide to Fitting and Design Challenges

This guide explores the history and evolution of scleral lenses, from original glass designs to modern mini-sclerals, medium-range, and full sclerals. It covers key fitting challenges, advantages like improved visual acuity for irregular corneas, and potential disadvantages, including difficulties in insertion and the risk of hypoxia. Through case studies of diverse patient demographics, the guide offers practical fitting tips and considerations for eye care professionals, highlighting when to use scleral lenses as a first choice versus a last resort.

zyta
Télécharger la présentation

Understanding Scleral Lenses: A Comprehensive Guide to Fitting and Design Challenges

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. LENS DYNAMICS, INC.

  2. SCLERAL HISTORY • Original contact lens • Hand ground glass lenses • Fit by casting a mold of the cornea

  3. EARLY SCLERAL PERFORMANCE • Difficult to fit • Hard to manufacture and reproduce • Corneal hypoxia • Very short wearing times • Corneal molding – The negative kind

  4. SCLERAL DEFINED • Mini-Sclerals – 12.5mm to 14.5mm • Medium Range Sclerals – 15.0mm to 18.0mm • Full Sclerals – 18.5mm to 28.0mm

  5. SCLERALS – FIRST OR LAST RESORT?

  6. WHY FIT A SCLERAL LENS? THE PRO: • To vault highly irregular corneas • To provide better visual acuity than soft lenses • To prevent lost lenses • New Oxygen permeable materials

  7. WHY FIT A SCLERAL LENS? THE CON: • Harder to fit • Harder to insert and remove • Can reduce metabolic waste removal • Potential for hypoxia • Harder to fit

  8. THE PRACTICAL: • First or Last Resort as a design? • Who fits sclerals at all? • Who fits sclerals as the design of First choice? • Who fits sclerals as a design of Last resort?

  9. THE DESIGN: • 13.0mm, 13.5mm, 14.0mm • Lathe cut on DAC ALM lathes • Spherical back and front surfaces • Normally NOT fenestrated

  10. HOW TO FIT • Start with a base curve close to average Ks • Trial for best alignment pattern as possible • Be sure there is NO conjunctival drag • Do spherical over-refraction • Need 0.5mm of movement

  11. FITTING TIPS • Fill concave side with saline/wetting drops into posterior of trial lens • Dip fluorescein strip into solution • Insert using 2 fingers to handle the trial lens with patient looking at floor • Low riding lens – select flatter base curve • Flatten base curve to solve edge tightening

  12. CASE HISTORIES

  13. 48 years old, Caucasian male, OD cornea • Can’t use bi-toric • Quadrant Specific base curve not indicated • Temporal/superior area eliminates reverse curve design • Select Semi-Scleral 13.5 design CASE 1

  14. 48 years old, Caucasian male, OD cornea • Average K is 47.00 D. or 7.18mm • Select 7.20mm BC from trial set, 13.5mm -4.00 • Acceptable fit with -2.25 over-refraction CASE 1

  15. 22 years old, African American male, OS cornea • Superior, peripheral area too steep for Quadrant Specific base curve • Bi-toric not indicated • Select Semi-Scleral 13.5 design CASE 2

  16. 22 years old, African American male, OS cornea • Average K is 47.00 D. or 7.18mm • Select 7.20 BC from trial set, 13.5mm • Lens too tight at edge and too much vaulting CASE 2

  17. 22 years old, African American male, OS cornea • Select trial lens 0.2mm flatter or 7.40mm • Acceptable fit • Perform spherical over-refraction CASE 2

  18. 31 year old Caucasion female, OD cornea • Bi-toric not indicated • Flatter areas too narrow for Quadrant Specific base curves • Reverse curve design not indicated • Select Semi-Scleral 13.5 design CASE 3

  19. 31 year old Caucasion female, OD cornea • Average K is 46.25 D. or 7.30mm • Select 7.30mm trial lens from trial set • Low riding lens-select flatter base curve CASE 3

  20. 31 year old Caucasion female, OD cornea • Select 7.50mm base curve from trial set • Acceptable fit with lens properly positioned • Perform spherical over-refraction CASE 3

  21. Questions?

More Related