Virtually-Designed Scleral Lens: Management of Extreme Corneal Ectasia
Tiffany Andrzejewski, OD, FAAO
Toric haptic scleral lens designs are prescribed more often than in previous years. Recent interest in mapping the sclera and conjunctiva is proving that scleral shape is highly variable and may explain the difficulty in fitting some patients with scleral lenses. Scleral lens fitting is also complicated by scleral irregularities such as blebs, nodules, and pingueculae. Designing a lens to fit over and around irregularities in addition to having a highly irregular corneal and scleral shape can pose especially difficult fitting situations. A corneo-scleral topographical system was utilized to evaluate ocular shape of a patient with extreme cornea ectasia following radial keratometry and LASIK surgery. Highly customized back surface scleral lenses with front toric optics were empirically designed to address the unusual scleral shape, which significantly deviated from a toric curve with 180 degrees of symmetry.