Prescription Habits of Scleral Lenses for the Management of Corneal Irregularity and Ocular Surface Disease Among Scleral Lens Practitioners

Abstract

Objectives: To describe prescribing patterns of therapeutic scleral lenses (SLs) in the management of corneal irregularity and ocular surface disease among practitioners who prescribe SLs. Methods: Participants ranked treatment options for corneal irregularity and ocular surface disease in the order they would generally consider using them in an electronic survey. Median rank score for each option is reported, along with the percentage of participants assigning first place ranking to each option. The percentage of participants assigning first, second, or third place ranking to each option is also reported. Results: Seven hundred and seventy-eight practitioners participated. Scleral lenses are most frequently considered as the first choice for the management of corneal irregularity based on overall median rank, followed by corneal rigid lenses (rigid gas-permeable [RGPs]). Scleral lenses were the first choice of 42% of participants, followed by RGPs (20%). For ocular surface disease, lubricant drops are most frequently used first, followed by meibomian gland expression, topical cyclosporine or lifitegrast, topical steroids, punctal plugs, and SLs, respectively. Lubricant drops were the first therapeutic option considered for ocular surface disease by 63% of participants and 45% ranked SLs as their sixth, seventh or eighth treatment based on median overall rank. Conclusions: Scleral lenses were identified as the first option for management of corneal irregularity more frequently than RGPs. Scleral lenses are considered for management of ocular surface disease before surgical intervention but after meibomian gland expression, punctal occlusion, and topical medical therapy are attempted.

Patient-Reported Dry Eye Treatment and Burden of Care

“…Scleral lenses are increasingly being used to manage dry eye disease after more conservative topical therapies fail. 19–21 However, the burden of care for contact lenses is relatively high compared with other therapeutic options for dry eye; in our experience, the cost, initial fitting, training in application and removal, and ongoing visits to ensure proper fit and lens care can be deterrents to lens use. Moisture chamber glasses or goggles also were more frequently introduced after the initial dry eye evaluation.…”

Patient Experiences With Therapeutic Contact Lenses and Dry Eye Disease

“…This finding is consistent with previous studies that have reported that SLs tend to be reserved for patients with more severe disease. 13,14 Mid-day fogging has been reported to occur in 26% to 46% of patients using SLs. [31][32][33][34][35] In this study, 75% of SL wearers reported issues with lens fogging or clouding of vision necessitating midday lens removal in 60% of those reporting the phenomena.…”

“…This finding is consistent with previous studies that have reported that SLs tend to be reserved for patients with more severe disease. 13,14…”

“…12 Therapeutic contact lenses are typically prescribed only after less invasive treatments, such as artificial tears, prescription eye drops, punctal occlusion, topical biologic agents, and in-office meibomian gland procedures fail to provide sufficient ocular surface protection or symptomatic relief. 13–15 The DEWS II report recommends therapeutic contact lenses including soft bandage and scleral lenses (SLs) be considered after lid hygiene, topical lubrication, in-office meibomian gland expression, and prescription topical medications have been prescribed. 15 Bandage lenses can protect the ocular surface from exposure and shearing effects of blinking.…”

Scleral Lenses: Current Practice and Future Directions

“…Some notable findings from these three papers include that scleral lenses have emerged as the first line choice option over rigid corneal lenses for management of corneal irregularity among survey participants, especially so among United States prescribers and prescribers at academic centers. 9 The second paper found that although the number of experienced scleral lens practitioners is increasing with the proportion in community practice increasing, the percentage of patients fit for uncomplicated refractive error remains very low at 2%, suggesting that other modes of correction make more sense for uncomplicated refractive error. It is disappointing to me, as someone who has seen the great impact scleral lenses can have in conditions such as Stevens-Johnson syndrome, graft-versus-host-disease, and exposure keratitis, that the percent-age of fits for ocular surface disease remains relatively low at 15%.…”