Dr. Daddi Fadel, a practicing optometrist, and a contact lens expert begins by defining the scleral lens, stating its advantages and contraindications. She dives straight into explaining the three-step scleral lens fitting process.
1. Patient selection (07:58)
a. No age limit (09:44)
b. Anomalies of corneal endothelium (10:08)
c. Diabetic or immunocompromised patients (11:25)
d. Glaucoma (11:40)
e. Sports contraindications (13:25)
f. Ocular Examination (14:06)
2. Trial lens selection (17:18)
a. Diameter (18:05)
b. Lens sagittal height (22:50)
3. Observation (24:50)
a. Center corneal clearance (26:34)
b. Peripheral corneal clearance (27:22)
c. Limbal clearance (27:54)
d. Blanching vs indentation (28:58)
e. Scleral toricity (32:24)
f. Edge fitting (41:30)
Dr. Fadel shows us the different patterns that we may see on fitting spherical scleral lenses on a toric sclera. We also discuss ordering the lens and the schedule for re-assessment of the lens fit. Lastly, we learn some tips and tricks for fitting scleral lenses
1. Air Bubbles (45:04)
2. Lens application techniques and devices (46:25)
3. Lens removal techniques and devices (53:32)
4. Debris or Midday fogging (55:44)
5. Poor wettability (56:05)
6. Light and observation when assessing the lens (59:30)
7. Empathetic Communication (58:55)
We conclude the session with some resources available for the audience. The session ends with a Q and A section for the live audience.
Fadel D, Kramer E. Potential contraindications to scleral lens wear. Cont Lens Anterior Eye. 2019 Feb;42(1):92-103.
Picot C, Gauthier AS, Campolmi N, Delbosc B. Qualité de vie des patients équipés en verres scléraux [Quality of life in patients wearing scleral lenses]. J Fr Ophtalmol. 2015 Sep;38(7):615-9.
Koppen C, Kreps EO, Anthonissen L, Van Hoey M, Dhubhghaill SN, Vermeulen L. Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus. Am J Ophthalmol. 2018 Jan;185:43-47.
Kornberg DL, Dou E, Wang Y, St Clair R, Lee MN, Sood P, Fernandez AA, Ciralsky JB, Sippel KC, Rosenblatt MI. Clinical Experience With PROSE Fitting: Significance of Diagnosis and Age. Eye Contact Lens. 2016 Mar;42(2):124-8.
O'Donnell C, Efron N. Corneal endothelial cell morphometry and corneal thickness in diabetic contact lens wearers. Optom Vis Sci. 2004 Nov;81(11):858-62.
Contact Lens Spectrum – Scleral lenses: Prepare for landing. Fadel, D.
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