SlideShare a Scribd company logo

A glimpse through scleral contact lenses (PROSE)

•Download as PPTX, PDF•
•
G
GREESHMA G

This document provides an overview of scleral contact lenses. It discusses what scleral lenses are, their evolution and uses, indications for fitting, anatomy considerations, fitting principles, and care and maintenance. Scleral lenses are large diameter gas permeable lenses that completely cover the cornea and rest on the sclera. They are used for conditions like corneal ectasia, scars, and degenerations to create a liquid bandage over the ocular surface and mask irregular astigmatism. Fitting involves assessing total diameter, clearance, landing zone alignment, and vault to provide a fluid reservoir and stabilize the lens.

1 of 29
Downloaded 150 times
GREESHMA G MPHIL FIRST YEAR A GLIMPSE THROUGH SCLERAL CONTACT LENSES
SCLERAL LENS 10/4/2016 2
WHAT IS PROSE???? • PROSE- Prosthetic replacement of ocular surface ecosystem • A PROSE device is a Scleral Contact Lens intended restore vision, support healing, reduce symptoms and improve quality of life for patients suffering with complex corneal disease 10/4/2016 3
ABOUT SCLERAL LENS • Scleral contact lenses (Haptic lenses) are large diameter gas permeable lenses which completely cover the cornea and rests on the sclera • Creates a liquid bandage over the ocular surface • Masks regular and irregular astigmatism • Useful for fragile and diseased corneas and for dry eyes 10/4/2016 4
EVOLUTION OF SCLERAL LENSES • First made 125 years ago • Smaller GP lenses and soft lenses 10/4/2016 5
TERMINOLOGY 10/4/2016 6
10/4/2016 7
WHEN WE WILL GO FOR SCLERAL LENSES?? 10/4/2016 8
INDICATIONS OF SCLERAL LENSES Corneal ectasia Corneal scars Corneal degenerations or dystrophies High refractive corrective errors Cosmesis and sports • keratoconus • keratoglobus • Pellucid marginal degeneration • Post LASIK • Post LASEK • Post PRK • Post RK • Post Trauma • Herpex simples virus • Terrien’s marginal degeneration • Salzmann’s nodular degeneration • Hyperopia • Myopia • High astigmatism • Aniridia • Albinism • Diving • Water skiing 10/4/2016 9
ADVANTAGES OF PROSE • Fluid reservoir- Supports healing and reduces symptoms • Protecting and shielding the cornea and conjunctiva • Improves stability • Optical neutralization of irregular astigmatism 10/4/2016 10
ANATOMY • Conjunctiva is the landing plane for scleral lenses • Conjunctiva: Structure less tissue • Sclera constitutes the shape of the anterior eye beyond the corneal borders • Scleral shape is not equal in all meridians 10/4/2016 11
PREREQUISITES BEFORE FITTING • Observe eye shape: lateral positions • Corneal topography: shape of cornea • Initial trial set • ASOCT 10/4/2016 12
SCLERAL LENS FITTING PRINCIPLES FITTING ASPECTS • Total lens diameter and optical zone diameter • Establishing the central and limbal clearance • Appropriate landing zone alignment • Adequate lens edge 10/4/2016 13
SCLERAL LENS FIT ASSESSMENT GUIDE 1. Front surface of lens 2. Center thickness (CT) 3. Clearance(1/2 of CT) 4. Corneal thickness 1.Amy Dinardo etal; Introducing scleral lens fit assessment guide based on tear layer thickness; Scleral lens fitting scales; GSLS; 2014;Ferris state university; WWW.ferris.edu 10/4/2016 14
10/4/2016 15
VAULT OF SCLERAL LENSES • Fluid reservoir • Increasing diameter increases vault • Vault reduces in short and long term scleral lens settling • Central clearance: 50 to 300 microns • No statistical correlation between vault and visual acuity • Trial : Minimum of 200 microns vault 1. George W Denaeyer; Scleral lens fitting success, Improve your scleral lens fitting success; CL spectrum; vol 29; Nov 2014; 22-25 10/4/2016 16
10/4/2016 17 Higher vault Limbal bearing nasally visible in the fluorescein pattern Mini-scleral lens with inadequate vault over corneal graft optic section
HAPTIC OF SCLERAL LENSES Edge lift • Scleral toricity • Flatter lens fit can cause edge lift • Edge lift can induce bubbles • Causes discomfort • Symblepharon • If EL is present then switch to small diameter lens or use a Toric back surface haptic Impingement • Steeper fit leads to blanching peripherally • Flatter lens seals mid periphery • Paralimbal injection • Difficult to remove • Avoid over pushing of lens • Discomfort • Reduces wearing time • Neo vascularization 10/4/2016 18
IMPINGEMENT • Long term settling occurs secondary to adaptive changes in bulbar conjunctiva • Bearing on ocular surface induces staining 10/4/2016 19 Impingement ring
10/4/2016 20 Local blanching underneath the landing zone of a large scleral lens Good haptic conjunctival fit Circum corneal blanching
10/4/2016 21 Scleral lens periphery impinging in a pingecula causing inflammation and hypertrophy
10/4/2016 22 Irregular corneas Preliminary examination Prose device fitting Optimum fit Three hour Six hour Day 1 Day 3Day 2
INSERTION OF THE DEVICE 10/4/2016 23
REMOVAL 10/4/2016 24
HISTORY TAKING • Vision with Scleral lenses • Comfort • Wearing hours • How often they changes saline- SJS patients 10/4/2016 25 SLIT LAMP EXAMINATION • Corneal clearance • Lens periphery- edge lift • Blanching
CARE AND MAINTENANCE • Not like Soft contact lenses or RGP lenses • GP PLUS solution • MPS crystal Solution • Unpreserved Saline • Sterile needle gauge 10/4/2016 26
SCLERAL LENS FIT SUCCESS • Successful fit: Patient comfortable with no or minimal signs of staining or injection after removal • Best time for observing early complication is three to six hours after wear • Look how lens sits on eye Impingement – conjunctival staining Compression- discomfort Vault contact – staining 10/4/2016 27
ACKNOWLEGMENT • Pic Courtesy- A Guide to scleral lens fitting_Eef Vanderworp 10/4/2016 28
10/4/2016 29 THANK YOU

More Related Content

A glimpse through scleral contact lenses (PROSE)

  • 1. GREESHMA G MPHIL FIRST YEAR A GLIMPSE THROUGH SCLERAL CONTACT LENSES
  • 3. WHAT IS PROSE???? • PROSE- Prosthetic replacement of ocular surface ecosystem • A PROSE device is a Scleral Contact Lens intended restore vision, support healing, reduce symptoms and improve quality of life for patients suffering with complex corneal disease 10/4/2016 3
  • 4. ABOUT SCLERAL LENS • Scleral contact lenses (Haptic lenses) are large diameter gas permeable lenses which completely cover the cornea and rests on the sclera • Creates a liquid bandage over the ocular surface • Masks regular and irregular astigmatism • Useful for fragile and diseased corneas and for dry eyes 10/4/2016 4
  • 5. EVOLUTION OF SCLERAL LENSES • First made 125 years ago • Smaller GP lenses and soft lenses 10/4/2016 5
  • 8. WHEN WE WILL GO FOR SCLERAL LENSES?? 10/4/2016 8
  • 9. INDICATIONS OF SCLERAL LENSES Corneal ectasia Corneal scars Corneal degenerations or dystrophies High refractive corrective errors Cosmesis and sports • keratoconus • keratoglobus • Pellucid marginal degeneration • Post LASIK • Post LASEK • Post PRK • Post RK • Post Trauma • Herpex simples virus • Terrien’s marginal degeneration • Salzmann’s nodular degeneration • Hyperopia • Myopia • High astigmatism • Aniridia • Albinism • Diving • Water skiing 10/4/2016 9
  • 10. ADVANTAGES OF PROSE • Fluid reservoir- Supports healing and reduces symptoms • Protecting and shielding the cornea and conjunctiva • Improves stability • Optical neutralization of irregular astigmatism 10/4/2016 10
  • 11. ANATOMY • Conjunctiva is the landing plane for scleral lenses • Conjunctiva: Structure less tissue • Sclera constitutes the shape of the anterior eye beyond the corneal borders • Scleral shape is not equal in all meridians 10/4/2016 11
  • 12. PREREQUISITES BEFORE FITTING • Observe eye shape: lateral positions • Corneal topography: shape of cornea • Initial trial set • ASOCT 10/4/2016 12
  • 13. SCLERAL LENS FITTING PRINCIPLES FITTING ASPECTS • Total lens diameter and optical zone diameter • Establishing the central and limbal clearance • Appropriate landing zone alignment • Adequate lens edge 10/4/2016 13
  • 14. SCLERAL LENS FIT ASSESSMENT GUIDE 1. Front surface of lens 2. Center thickness (CT) 3. Clearance(1/2 of CT) 4. Corneal thickness 1.Amy Dinardo etal; Introducing scleral lens fit assessment guide based on tear layer thickness; Scleral lens fitting scales; GSLS; 2014;Ferris state university; WWW.ferris.edu 10/4/2016 14
  • 16. VAULT OF SCLERAL LENSES • Fluid reservoir • Increasing diameter increases vault • Vault reduces in short and long term scleral lens settling • Central clearance: 50 to 300 microns • No statistical correlation between vault and visual acuity • Trial : Minimum of 200 microns vault 1. George W Denaeyer; Scleral lens fitting success, Improve your scleral lens fitting success; CL spectrum; vol 29; Nov 2014; 22-25 10/4/2016 16
  • 17. 10/4/2016 17 Higher vault Limbal bearing nasally visible in the fluorescein pattern Mini-scleral lens with inadequate vault over corneal graft optic section
  • 18. HAPTIC OF SCLERAL LENSES Edge lift • Scleral toricity • Flatter lens fit can cause edge lift • Edge lift can induce bubbles • Causes discomfort • Symblepharon • If EL is present then switch to small diameter lens or use a Toric back surface haptic Impingement • Steeper fit leads to blanching peripherally • Flatter lens seals mid periphery • Paralimbal injection • Difficult to remove • Avoid over pushing of lens • Discomfort • Reduces wearing time • Neo vascularization 10/4/2016 18
  • 19. IMPINGEMENT • Long term settling occurs secondary to adaptive changes in bulbar conjunctiva • Bearing on ocular surface induces staining 10/4/2016 19 Impingement ring
  • 20. 10/4/2016 20 Local blanching underneath the landing zone of a large scleral lens Good haptic conjunctival fit Circum corneal blanching
  • 21. 10/4/2016 21 Scleral lens periphery impinging in a pingecula causing inflammation and hypertrophy
  • 22. 10/4/2016 22 Irregular corneas Preliminary examination Prose device fitting Optimum fit Three hour Six hour Day 1 Day 3Day 2
  • 23. INSERTION OF THE DEVICE 10/4/2016 23
  • 25. HISTORY TAKING • Vision with Scleral lenses • Comfort • Wearing hours • How often they changes saline- SJS patients 10/4/2016 25 SLIT LAMP EXAMINATION • Corneal clearance • Lens periphery- edge lift • Blanching
  • 26. CARE AND MAINTENANCE • Not like Soft contact lenses or RGP lenses • GP PLUS solution • MPS crystal Solution • Unpreserved Saline • Sterile needle gauge 10/4/2016 26
  • 27. SCLERAL LENS FIT SUCCESS • Successful fit: Patient comfortable with no or minimal signs of staining or injection after removal • Best time for observing early complication is three to six hours after wear • Look how lens sits on eye Impingement – conjunctival staining Compression- discomfort Vault contact – staining 10/4/2016 27
  • 28. ACKNOWLEGMENT • Pic Courtesy- A Guide to scleral lens fitting_Eef Vanderworp 10/4/2016 28

Editor's Notes

  1. Minimum of 200 microns should be over vaulted in cornea on trial set to get the desired CCC Increasing diameter allows the scleral lens to create more vault Adequate vault: 16mm lenses (normal corneas)
  2. Spherical haptic will often misalign1 Sclera is non rotationally symmetrical Well fit: CL will rest on bulbar conjunctiva without significant compression, impingement or areas of edge lift In a spherical haptic, small areas of blanching are acceptable as patient is comfortable and less significant resistance on lens removal Severe compression can leads to seal off, 360 degree peripheral blanching with para limbal injection, lens will be difficult to insert and remove ( so flatten the PC or switch the design) Over pushing lens during trial can cause a temporary blanching, after settling it will disappear