Contact Lens Spectrum Supplements

Special Edition 2017

Contact Lens Spectrum

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C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 7 c l s p e c t r u m . c o m 42 SCLERAL LENSES hand. In clinical practice, patients with signs and symp- toms of dry eye disease are more likely to experience contact lens discomfort. 19 In addition, dry eye becomes increasingly frequent with advancing age, which may exacerbate contact lens discomfort. Because scleral lenses protect and bathe the ocular surface, they are excellent for patients with presbyopia and dry eye. For patients with otherwise healthy eyes who have astigmatism, presbyopia, and dry eye, scleral lenses are good options. An in-office demonstration is extremely beneficial for these patients. SCLERAL LENSES FOR ATHLETES Many of the characteristics of scleral lenses make them particularly well suited to athletes, and practitio- ners often prescribe them for patients with healthy eyes who participate in sports, including snow and water ski- ing, bicycling, and gymnastics. Just the fact that scleral lenses remain stable without dislodging with quick movements make them a fantastic option for athletes. What's more, athletes are often exposed to chal- lenging environmental conditions, such as wind, dust, chalk, or sand, all of which can lead to discomfort with soft contact lenses, and particularly with small-diameter GP lenses. As scleral lenses provide a sealed ocular sur- face environment, eyes are protected from all elements. Athletes also have demanding visual needs. Crisp, sta- ble, clear, consistent vision is essential for optimal athlet- ic performance, and scleral lenses provide these benefits. The large customizable optic zone is generally advanta- geous but particularly for athletes with large pupils who experience nighttime flare and glare with pupil dilation. Scleral lenses can vastly improve the quality of life for athletes, particularly those who no longer enjoy their sporting activity because of discomfort and instability scleral lens group (≥70 for 81% of patients). 17 Researchers have also evaluated scleral lenses in asymptomatic patients with low-to-moderate (0.75D to 2.75D) refractive astigmatism. A multisite prospec- tive crossover clinical study evaluated comfilcon A (Biofinity, CooperVision) soft toric lenses and hexafocon A (Boston XO, Bausch + Lomb) 14.3 mm diameter mini- scleral lenses in 36 patients. 18 Patients wore each modal- ity for 2 weeks and then switched modalities. One group wore soft toric lenses first, the other group wore mini- scleral lenses first. Patients preferred the vision of the mini-scleral lenses by 75% compared with the soft toric lenses in this study. There were no significant differenc- es between the two groups in wearing time, subjective comfort, and objective vision. While 52.7% preferred to continue with mini-scleral lens wear, only 38.8% re- ported these mini-scleral lenses were easy or very easy to handle. 18 Keep in mind that patients in this study were asymptomatic and still preferred the vision and wanted to continue with mini-scleral lenses. Thus, large-diame- ter GP lenses can be a good alternative to soft toric lenses to correct refractive astigmatism. These results suggest the value of offering an in-office on-eye demonstration of scleral lenses to current soft toric contact lens wearers. Transitioning patients from other contact lens mo- dalities to scleral lenses is not difficult and may improve their contact lens experience. Consider patients with common refractive errors such as myopia, regular astigmatism, hyperopia, and presbyopia. If vision or comfort is not optimal with the current contact lens modality, offer the option of scleral lenses. If small amounts of spherical refractive error are present, other contact lens modalities (soft, hybrid, small-diameter GP) may be acceptable, but for patients who have significant refractive error, particularly if astig- matism is present, scleral lenses are beneficial. Even with eye movement, scleral lenses remain relatively stable on the eye. Also consider scleral lenses for patients with astigma- tism who notice fluctuating vision with soft toric lenses. Visual flux may occur with certain activities, such as changing view from a digital device to distance, or with physical movement and exercise. With their crisp GP optics and exceptional stability, scleral lenses maintain clear and consistent vision all day. Scleral lenses are also ideal for patients with presbyopia and concomitant dry eye. There are numerous multifocal scleral lens options, including dual aspheric, center-dis- tance, and center-near designs, that provide exceptional vision at all distances. Of note, multifocal scleral lenses can also be used in patients with irregular corneas. SCLERAL LENSES FOR DRY EYES Dry eye and contact lens dropout seem to go hand in Figure 2. Inferior bubble in the post lens fluid reservoir.

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