Outcomes of Scleral Contact Lens Use in Veteran Population

Abstract

Objectives: To document outcomes associated with use of scleral contact lenses (SL) in the veteran population and analyze the medical and demographic factors that affect these outcomes, specifically those involved in contact lens discontinuation. Methods: A retrospective study of consecutive patients first fitted with Jupiter Scleral lenses at the Michael E. DeBakey Veterans Affairs Medical Center between 2010 and 2018. The primary outcome was continuation of SL use at 1 year. Demographic factors and variables such as presence of comorbid diseases, improvement in visual acuity, and daily lens wear time were compared. Logistic regression analysis was used to determine which factors were associated with SL discontinuation. Results: One hundred twenty patients with a mean age of 56.7±15.1 years were fitted with SL during the study period. The most common diagnosis was corneal ectasia (55.8%). Sixty-six (55.0%) patients had difficulty with wear, the most common being ocular irritation (20.0%) and mid-day fogging or bubbles (15.8%). Forty-one patients (34.2%) discontinued SL use with a median time from fitting to discontinuation of 5.2 months. The most common reason for SL discontinuation was difficulty with insertion and removal (53.7%). Comorbid neurologic disease had a statistically significant association with discontinuation (odds ratio 4.6, 95% confidence interval 1.3–17, P=0.022). There were statistically significant differences in mean visual acuity improvement (P=0.003) and daily wear time (P<0.001) but not age (P=0.70) between patients who continued and discontinued lens use. Conclusions: Scleral contact lenses are effective for treating a wide variety of ocular diseases and have positive outcomes in veterans. This study aids in understanding patient factors that affect outcomes of SL use in veterans. Further prospective studies are needed to make formal recommendations regarding candidate selection.

BCLA CLEAR - Scleral lenses

“…During the 1980's, when scleral lenses were first manufactured in gas permeable materials [13][14][15][16]22], the most common conditions treated were; high ametropia (aphakia and myopia, 44 %), primary corneal ectasia (keratoconus, pellucid marginal degeneration, keratoglobus, 32 %), post-penetrating keratoplasty (12 %), and ocular surface disease (7 %) (based on a weighted analysis of Ezekiel, Pullum, and Trodd [13,23]. Since the advent of silicone hydrogel soft contact lenses used for the refractive correction of aphakia and high myopia, the most common clinical conditions treated with modern highly oxygen permeable scleral lenses are; primary corneal ectasia (53 %), ocular surface disease (18 %), and post-penetrating keratoplasty (17 %) (weighted analysis of data [6,[24][25][26][27][28][29][30][31][32][33][34][35]. Modern scleral lenses are also used for the correction of simple refractive errors, including presbyopia, particularly when other modalities fail due to vision or comfort issues [36].…”

BCLA CLEAR - Contact lens complications

“…Mid-day fogging. Mid-day fogging is the most common visual complication of scleral lens wear and has been noted in 16-85% of wearers [501,503,[513][514][515][516]. Fogging likely occurs due to accumulation of debris in the tear reservoir beneath the scleral lenses or poor wetting of the contact lens back surface.…”