Scleral lenses – an overview

Scleral lenses are large diameter gas permeable lenses that rest on the sclera, the white part of the eye, and over the cornea. They are specially designed to treat a variety of eye conditions, and often provide relief and improved vision when other types of lenses are ineffective.

How do scleral lenses work?

Unlike standard contact lenses, scleral lenses work by creating a fluid-filled reservoir between the back surface of the lens and the cornea. This layer of fluid helps smooth out irregularities on the surface of the cornea, leading to improved vision.

Furthermore, this design helps to keep the cornea moist, which is especially useful in the treatment of ocular surface diseases such as dry eye syndrome or Sjögren's syndrome. By maintaining a constant layer of fluid, scleral lenses can help relieve dryness and discomfort associated with these conditions.

Types of scleral lenses

Scleral lenses can be classified into three main categories based on their size and where they rest on the sclera:

1. Mini-scleral lenses: These lenses rest on the front sclera and are larger than traditional contact lenses but smaller than scleral lenses.
2. Scleral lenses: These are larger than mini-sclerals and cover more than the sclera, and often provide better stability and comfort.
3. Hybrid scleral lenses: These lenses combine a soft lens skirt with a rigid gas permeable lens center. They offer the comfort of soft lenses with the vision-enhancing properties of rigid gas permeable lenses.

Placing scleral lenses

Placing scleral lenses includes several specific steps:

1. Lens preparation: fill the lens with sterile saline before placing it on the eye. This creates the reservoir of fluid that rests on the cornea.
2. Lens insertion: Look straight ahead into the mirror, use one hand to hold the upper and lower eyelids open. With the other hand, hold the lens with a specially designed suction holder or with your fingers and gently place it on the eye.
3. Positioning the lens: Once the lens is on the eye, it must be centered over the cornea. If not, you may need to gently maneuver the lens into the correct position.

Maintaining hygiene

Scleral lenses require careful care to maintain hygiene and prevent infections.
Here are some guidelines:

1. Hand hygiene: Wash your hands thoroughly before handling the lenses.
2. Lens Cleaning: After removal, clean the lenses with the recommended lens cleaning solution. Never use tap water, as it may contain bacteria and other microorganisms that can cause serious eye infections.
3. Lens storage: Store lenses in a clean lens case filled with fresh disinfecting solution. Change the lens case regularly, at least every three months.
4. Regular checkups: Have regular checkups with your eye doctor to make sure your lenses fit properly and your eyes are healthy.

cost and efficiency

The cost of scleral lenses can vary widely, depending on the complexity of the fit and the specific condition they treat. They can range from NIS 1000-2000 per lens or more. Although this may seem expensive compared to standard contact lenses, the cost can be justified by their effectiveness, especially when other treatment options have failed.

For patients with irregular corneas or severe dry eye disease , scleral lenses can dramatically improve vision and comfort, leading to a better quality of life. They may also reduce the need for more invasive or expensive treatments, making them a cost-effective option in the long run.

Keeping lenses clean and preventing infections

A crucial aspect of fitting scleral lenses, or any contact lenses, is ensuring they are clean to avoid potential eye infections. Here are some more recommendations:

1. Daily cleaning: After removing the lenses, clean them thoroughly using a cleaning solution recommended by your eye doctor. Rub the lenses gently with your fingers to remove any deposits, then rinse with the cleaning solution. Never use tap water for washing.
2. Disinfection: after cleaning, the lenses must be disinfected using an antiseptic solution. Leave the lenses in the solution for the recommended time.
3. Proper storage: Store your lenses in a clean, dry lens case. After installing the lenses, clean the case with a sterile solution (not tap water), wipe with a clean tissue and leave it open to air dry.
4. Protein removal: Over time, protein deposits may accumulate on the lenses. Use a protein removal product as recommended by your eye doctor.
5. Regular replacement: Scleral lenses, like all contact lenses, must be replaced regularly to maintain eye health. The replacement schedule will depend on the specific lenses and your eye doctor's recommendation.

In conclusion, scleral lenses are a powerful tool in the management of various eye conditions, providing improved vision and comfort. However, it is important to remember that their successful use requires careful handling, thorough cleaning and regular eye examinations. With proper care and maintenance, these lenses can significantly improve the quality of life for those with complex eye conditions.

Credit: Dr. Itamar Arbel
Website: www.drarbel.co.il