For patients suffering from moderate to severe dry eye disease, scleral lenses are more than just a vision correction tool—they’re a therapeutic treatment. These lenses create a fluid reservoir over the ocular surface, offering continuous hydration and mechanical protection throughout the day. But how do we, as clinicians, monitor progress once a patient begins scleral lens wear?
We can easily monitor symptom progress with validated questionnaires like the Ocular Surface Disease Index (OSDI)¹ or the Symptom Assessment iN Dry Eye (SANDE)² visual analog scale questionnaire. They are easy to administer before dry eye treatment of any sort including scleral lenses. To monitor objective findings, the Medmont Meridia™ Pro has a dry eye suite that allows you to monitor meibomian glands, tear film surface quality, non-invasive tear breakup time, tear meniscus height and anterior segment imaging of staining. The imaging can also document your fit along the way.
What is the OSDI?
The Ocular Surface Disease Index is a validated 12-item questionnaire. It measures symptoms related to ocular irritation, vision-related function, and environmental triggers. The score ranges from 0 to 100, with higher scores indicating more severe symptoms:
- 0–12: Normal
- 13–22: Mild dry eye
- 23–32: Moderate dry eye
- 33–100: Severe dry eye
It’s quick to administer—patients complete it in under 5 minutes—and the results offer a standardized, repeatable metric of subjective symptom burden.
What is the SANDE questionnaire?
The Symptom Assessment iN Dry Eye is a 2-question survey using a visual analog scale. Patients draw an x along a 100 mm line rating their experience with dry eye symptom frequency and severity. The score is simply measuring where the “x” is from the left side of the scale. It has been shown to be repeatable and correlates with the OSDI.³
Using the questionnaires to Monitor Scleral Lens Success
Scleral lenses often improve symptoms of dry eye during lens wear; reduced staining, improved tear film stability, and better corneal integrity can occur during wear as well. However, patients may still report discomfort, fluctuation in vision, or fatigue. The OSDI and/or SANDE can bridge that gap between objective findings and the subjective patient experience.
Here’s how you can incorporate it:
- Baseline Measurement: Administer the questionnaire(s) before scleral lens fitting. This serves as the patient’s baseline and helps identify key symptom drivers.
- Follow-Up Tracking: Repeat the questionnaire(s) at each major follow-up (e.g., 1 month, 3 months, 6 months). Document changes in score alongside slit-lamp findings, corneal and conjunctival fluorescein or lissamine green staining, meibography, tear film quality either with or without scleral lenses, tear breakup time, and anterior segment photography.
- Trend Recognition: A decreasing questionnaire score suggests improvement in both OSDI and SANDE—even if the patient struggles to verbalize it. Conversely, a plateau or increase may signal issues such as midday fogging (either under or on the surface of the lens), poor compliance, tearfilm instability on the surface of the lens, or underlying inflammation.
- Patient Empowerment: Sharing questionnaire results with patients fosters engagement. When they can see their symptom improvement in numbers, they better understand the value of continued care, compliance, and follow-up. Objective documentation like images and graphs can also demonstrate improvement after scleral lenses are employed
By integrating the symptom questionnaires into your scleral lens protocol, you’ll gain a fuller picture of how your patients are truly doing—not just anatomically, but functionally and emotionally. These tools enhance your ability to guide care, justify treatment plans, and demonstrate outcomes to both patients and referring providers.
Learn more about the Medmont Meridia Pro here.
- Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Archives of ophthalmology. 2000 May 1;118(5):615-21.
- Schaumberg, D. A., Gulati, A., Mathers, W. D., Clinch, T., Lemp, M. A., Nelson, J. D., Foulks, G. N., & Dana, R. (2007). Development and validation of a short global dry eye symptom index. The ocular surface, 5(1), 50–57. https://doi.org/10.1016/s1542-0124(12)70053-8
- Amparo, F., Schaumberg, D. A., & Dana, R. (2015). Comparison of Two Questionnaires for Dry Eye Symptom Assessment: The Ocular Surface Disease Index and the Symptom Assessment in Dry Eye. Ophthalmology, 122(7), 1498–1503. https://doi.org/10.1016/j.ophtha.2015.02.037
