A glimpse through scleral contact lenses (PROSE)

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GREESHMA G MPHIL FIRST YEAR A GLIMPSE THROUGH SCLERAL CONTACT LENSES

Transcript of A glimpse through scleral contact lenses (PROSE)

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GREESHMA G

MPHIL FIRST YEAR

A GLIMPSE THROUGH SCLERAL CONTACT LENSES

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SCLERAL LENS

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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

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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

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EVOLUTION OF SCLERAL LENSES

• First made 125 years ago

• Smaller GP lenses and soft lenses

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TERMINOLOGY

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WHEN WE WILL GO FOR SCLERAL LENSES??

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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

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ADVANTAGES OF PROSE

• Fluid reservoir- Supports healing and reduces symptoms• Protecting and shielding the cornea and conjunctiva• Improves stability• Optical neutralization of irregular astigmatism

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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

 

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PREREQUISITES BEFORE FITTING

• Observe eye shape: lateral positions• Corneal topography: shape of cornea • Initial trial set• ASOCT

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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

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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

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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

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Higher vault Limbal bearing nasally visible in the

fluorescein pattern

Mini-scleral lens with inadequate

vault over corneal graft optic section

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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

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IMPINGEMENT

• Long term settling occurs secondary to adaptive changes in bulbar conjunctiva

• Bearing on ocular surface induces staining

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Impingement ring

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Local blanching underneath thelanding zone of a large scleral lens

Good haptic conjunctival fit

Circum corneal blanching

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Scleral lens periphery impinging in a pingecula causing inflammation and hypertrophy

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Irregular corneas

Preliminary examination

Prose device fitting

Optimum fit

Three hour Six hour

Day 1

Day 3Day 2

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INSERTION OF THE DEVICE

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REMOVAL

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HISTORY TAKING

• Vision with Scleral lenses

• Comfort

• Wearing hours

• How often they changes saline- SJS patients

SLIT LAMP EXAMINATION• Corneal clearance

• Lens periphery- edge lift

• Blanching

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CARE AND MAINTENANCE

• Not like Soft contact lenses or RGP lenses

• GP PLUS solution

• MPS crystal Solution

• Unpreserved Saline

• Sterile needle gauge

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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

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ACKNOWLEGMENT

• Pic Courtesy- A Guide to scleral lens fitting_Eef Vanderworp

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THANK YOU