Presented by:

Umair Wakeel

Scleral Lenses
OUTLINES

 Scleral lenses
 Terminology
 Anatomy
 History
 Indications
 Design
 Lens fitting
 Adverse events
 Patient compliance
SCLERAL LENS

 Also known as “Haptic” lens

 Haptic = sense of touch
 A large diameter rigid contact lens that cover
the entire surface and rest on sclera
 Diameter = 15mm to 25mm
 Minimum or no contact on cornea
TERMINOLOGY
Ocular Anatomy

 Average corneal diameter is 11.8mm

 The maximum diameter a Scleral lens can
have is 24mm.
HISTORY

 1880’s :
 1st scleral lens made of glass blown shells with
large size
 Cause pain, discomfort, complications
 1940’s :
 Discovered PMMA
 But low oxygen permeability (DK almost 0),
oxygen deprivation
 Cause corneal oedema & neovascularization
Cont….

 1970’s :
 Scleral lenses were disused
 Soft CL & RGP are preferred
 Now :
 Back to the market
 To fit on more challenging eyes
INDICATIONS

 Vision improvement
 Corneal protection
 Cosmesis
 Sports
 Drug delivery
Vision Improvement

 Mainly for corneal ectasia cases

 Primary = Keratoconus, Keratoglobus, PMD
 Secondary = post refractive surgery ( LASIK,
LASEK, PRK )
 Other Conditions : post trauma, corneal scar
due to infection
 To restore and improve vision
Corneal Protection

 In 2 conditions :
 Severe ocular disease (sjogren syndrome, Steven
Johnson syndrome)
 Incomplete lid closure (eyelid coloboma,
ectropian, exophthalmos, nerve palsies)
▪ Help by reducing corneal exposure to air (not to close
the eye)
Cont…

 Benefits :
 To relieve symptoms of pain & discomfort
 Keep ocular surface moist in severe dry eyes by
fluid reservoir retention
 Slow the progression of corneal disease & delay
the need of surgery
 Decrease risk of scarring
Cosmesis

 In prosthetic eye
 Full ocular prostheses
 Partial prostheses
 Use on :
 Aniridia
 Albinism
 Trauma
 Nanophthalmos
Sport

 More secured – reduce risk of loss

 Provide stable vision & comfort
Drug Delivery

 Scleral lens has tear reservoir

 Instill drug onto the bowl of scleral lens
 RGP is not suitable for drug delivery, due to
lens movement
Design of Scleral Lens
Optical Zone

 Minimal / not contact with cornea (RGP: Contact)

 Large size (RGP : smaller)
 Give optical effect
 Surface :
 Anterior surface : Aspheric design to reduce
photophobia & aberrations
 Posterior surface : same shape as cornea
 Sagital height of scleral lens is higher than
RGP
 Transitional Zone
 Connect cornea and sclera
 It set the Sagital height
 Changing sagital height means change the transitional
zone(flatter or steeper)
 Depends on the shape of the sclera
 The transitional zone for smaller diameter ScCL may rest
on limbal area, not for larger diameter ScCL
 Range of transition zone = 0.5mm to 2mm
Landing Zone/ Haptic Zone

 Area of scleral CL that rest on sclera

 Important to know:
 Size of landing zone
 Angle of landing zone
 Can make peripheral toric by thinning the
edge like prism ballast
 Increase diameter of landing zone, make it
more comfortable to wear as less movement
produced
Scleral Shape
 Referring to cornea, limbus & sclera
 Affect the scleral CL fitting
 Involve the transitional & landing zone
 The sclera can be evaluated using:
 Pentacam
 Anterior segment OCT
 Type of limbal Profile:
1. Gradual convex
2. Gradual tangential (common)
3. Convex concave
4. Marked convex (common)
5. Marked tangential
Limbal Angle & Scleral Angle

 This is angle b/w iris & cornea

 Temporal angle larger than nasal angle
 Scleral CL easily decentered to nasal side
 However, it would not affect vision because
the optical zone is large
Scleral Lens Fitting
Lens Insertion
Fitting Spherical Scleral Lenses

 Four step Approach :

1. Choose diameter
2. Establish central and limbal clearance
3. Landing zone alignment
4. Adequate edge lift
Choosing the Diameter

 Depends on anterior ocular sagital height

 Factors affecting sagital height evaluate:
 Corneal curvature
 Asphericity
 HVID
 Shape of anterior sclera (difficult to evaluate)
 Common diameter used is 15mm to 18mm
Optical/Clearance Zone Diameter

 Optical zone important to provide good

optical outcome and corneal clearance
 Clearance zone = optical zone + transition
zone
 Usually 0.2mm larger than HVID
 Size depends on lens designs
 Can be altered to improve corneal & limbal
clearance
Clearance

 Up to 600 microns of corneal clearance can be

easily achieved if needed centrally
 Large or Small sagital height should be used
instead of steep or flat
 Minimum of 100 microns is desired at any place
 Sagital depth differ with the conditions
 Ectasia needs less than post- corneal graft
 Ocular surface disease management requires large
sagital height
Evaluating Corneal Clearance
 start with low sagital height and gradually increase
height to desired clearance
 A green fluorescein pattern will be visible
 Use a thin optical section with brightest illumination
setting at a 45° angle
 If CCT known, compare corneal thickness to tear
layer thickness to estimate clearance
 If CCT not known, assume 530 micron cornea and
compare to the slit
Evaluating Central Corneal Clearance
Evaluating Peripheral Corneal
Clearance
 Ideally no touch and limbal clearance should
be obtained
 if clearance is <20 microns, underlying
fluorescein band may not be identify – look
for staining
Limbal Clearance

 Avoid mechanical pressure in the limbal area

 If good central clearance achieved but limbal
clearance is absent, change the limbal
clearance zone
 Flattening BC – reduces pressure
 Change transition zone angle
 Increase OZ diameter
Landing Zone Fit

 Aligning the periphery of the lens with the

scleral shape
 A ring of bearing on the inner part of the
landing zone indicates a flat landing zone
 A ring of bearing on outer part of the landing
zone indicates a steep landing zone
 Increasing the size of the landing zone
relieves pressure if needed
Lens Edge Lift
 Assess lens edge lift after 30 min of lens installation
during fitting process
 Also assess lens edge after 3-4 hours of lens wear
 Too much edge lift:
▪ Causes lens awareness & discomfort
▪ Action : decrease the edge lift by changing the landing
zone angle or by choosing a smaller landing zone radius of
curvature
 Low edge lift :
▪ It leaves a full or partial impingement ring on the
conjunctiva after lens removal
Cont….

 Two easy methods :

 Observe the edge lift with white light & how much
it “sinks” into the conjunctiva
 Push in method – preferred if the lens shows some
mobility
 Remove lens and evaluate surface with fluorescein
staining
Adverse Events
Cont…
Cont…
Patient Compliance

1. Hygiene :
 Cleaning kit same as RGP, must using protein
cleaner
 If deposit on lens present, first see Giant
Papillary Conjunctivitis
2. Sleeping with Scleral contact lenses:
 Advice patient not to wear scleral lens
extendedly to avoid complications.