Instrumentation for scleral lens fits
In the dynamic landscape of eye care, the utilization of advanced instrumentation has become pivotal in shaping the design and fitting of scleral lenses. These specialized contact lenses, designed to vault over the cornea and rest on the sclera, require precision and customization for optimal vision correction and comfort. The integration of cutting-edge instrumentation into clinical practices not only enhances the accuracy of scleral lens fittings but also empowers practitioners to provide individualized solutions for patients with irregular corneas or complex refractive needs. The combination of advanced technology and clinical skill not only makes the fitting process smoother but also improves the overall quality of care, representing a significant advancement in contact lens practice. The following imaging options can be incorporated into practice in order to stream-line scleral lens fits.
Corneal Topography
A non-invasive medical imaging technique for mapping the anterior curvature of the cornea.
Useful in diagnosis of corneal conditions and follow up care
Useful for ordering corneal GP lenses
Scleral Lens Use
Although this imaging technique does not directly measure the sclera, studies have shown that limbal elevation map results are similar to that of the scleral surface surrounding it.
For example: a steep superior cornea may have a steeper superior scleral surface
Scleral surface has been shown to be steepest in the same axis of the apex of the cone in Keratoconus patients
Using corneal topography to determine the axis of the cone may help the practitioner determine the steepest area of the sclera which may be useful in scleral lens fits
Optical Coherence Tomography
A non-invasive imaging technique that uses light waves to take cross section pictures of the anterior and posterior segments of the eye.
Can view the posterior segment: macula / optic nerve head fibers
Can view the anterior segment: cornea and scleral lenses
Scleral Lens Use
Provides information about the fluid reservoir and landing zone using a diagnostic fitting set
Challenges
Single meridian measurements that can be time consuming
Lack of software modules for lens fitting
$$
Benefits
Billable machine for exams
Multi-use as it can be used for disease management
Scheimflug Tomography
A non-invasive imaging technique that evaluates the front and back surfaces of then cornea and portions of the front of the eye.
Provides information on the front and back surfaces of the cornea
Provides global pachymetry measurements
Scleral Lens Use
No fluorescein required
5 measurements provided - straight ahead and 4 quadrants
Cornea and scleral measurements up to 18mm
Can provide information on anterior segment for custom scleral lenses
Disadvantages
Difficulty with measurements with small eyes
$$
Corneo-Scleral Topography
A non-invasive imaging technique that can measure both the cornea and scleral surfaces.
Allows for matching scleral lens LZ design with scleral shape
Provides information needed for custom scleral lens designs
Provides the following information:
Mean sagittal height
Sagittal height specified location
Scleral toricity
Scleral asymmetry
Machine options
sMAP 3D
Flourescein based
3 gazes provided
Assessment of cornea and scleral up to 22mm
Eye Surface Profiler
Flourescein based
Straight gaze measurement
Assessment up to 20mm
Diagnostic lens fitting
Disadvantages
Not multi-use, used only for contact lens fittings
Space for machine
$$
When deciding whether to incorporate any of these imaging techniques into your practice, consider how this fits into your business model. New technology can serve as a great marketing strategy that proves to patients that you’re dedicated to maintaining up to date with current management options. These devices can streamline your scleral lens fits, allowing for less chair time and increased number of fits. The information provided can improve the accuracy of scleral lens fits and therefore provide better patient outcomes.
