Ever wonder what problems your colleagues are running into with scleral lenses? The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group looked into just that! In 2014, SCOPE investigators formed a multicenter research study group that studies scleral lenses and practice habits. In the March 2023 edition of Eye and Contact Lens, Muriel Schornack, et al. surveyed 639 scleral lens practitioners encompassing 72,605 patients wearing scleral lenses and described the complications they encountered over a one-year period.
Demographics of the scleral lens practitioners:
Of the 639 scleral lens practitioners, 410 reported that they were from the United States and saw 49,067 scleral lens patients during the previous year, and 227 were international who saw 23,498 patients. They were queried about their practice modality and 472 were in private, group or commercial practice whereas 138 practiced in academic centers. There were 511 experienced practitioners with 5 or more years of fitting.
Why were scleral lenses temporarily or permanently discontinued?
Schornack and colleagues investigated microbial keratitis, corneal neovascularization, corneal edema, and limbal stem cell deficiency. Of the 72,605 patients included in this survey-based study, 325 (0.45%) discontinued lenses due to microbial keratitis. Corneal edema was found in 869 (1.2%) patients, and the number of cases of both microbial keratitis and edema reported was higher in community-based settings rather than academic settings. Lenses were discontinued due to corneal neovascularization in 385 (0.53%) wearers, and 135 (0.20%) patients developed limbal stem cell deficiency. There was no difference in reports of these events based on practitioner experience level, however practitioners from outside of the United States reported higher rates of these findings in all 4 categories.
Important to note….
Since this is a survey study, it was dependent on the recall of the participants so reports may be over- or underestimated. Complication rates may be skewed compared to a non-survey multicenter study of scleral lens wearers. When it comes to looking at the demographics of the patients, some may have more severity than others with less alternative options so they may need to maintain wear despite some ocular findings. Despite these limitations, this study provides valuable insight into what our peers are seeing in their practices.
Example of microbial keratitis.
So, what does this mean?
Scleral lenses are crucial for visual rehabilitation and ocular surface disease; however, practitioners should be cautious when selecting candidates. Patients should be made aware of potential risks with scleral lenses since they are medical devices. Careful education on lens care, handling and warning signs (redness, pain, discharge, change in vision, and light sensitivity) can potentially lessen the risk of microbial keratitis or at least alert patients to return to the clinic for other complications. Practitioners should also encourage strict follow-up schedules to monitor the health and safety of the lenses.
Schornack MM, Nau CB, Harthan J, Shorter E, Nau A, Fogt J. Survey-Based Estimation of Corneal Complications Associated with Scleral Lens Wear. Eye Contact Lens. 2023 Mar 1;49(3):89-91. doi: 10.1097/ICL.0000000000000972. Epub 2023 Jan 4. PMID: 36602410; PMCID: PMC9974798.