Scleral lenses are used to correct a wide range of issues, such as corneal irregularities, ocular surface disorders, postsurgical corneal dissatisfaction, high anisometropia and less severe refractive errors. In children, however, scleral lens fitting presents particular challenges due more to the child’s lack of cooperation and responsibility than to the pediatric anatomical ocular structure, researchers say. In their study, published in Eye & Contact Lens, they reported on miniscleral designs in pediatric patients and found them to be safe, helpful modalities.

The study included the medical records of 52 pediatric patients (72 eyes) fitted with miniscleral lenses over a nine-year period. Patients had initially been referred to Farabi Eye Hospital in Tehran due to inadequate spectacle-corrected visual acuity (VA), gas permeable or soft contact lens intolerance.

The researchers listed the following indications for miniscleral design lens fitting: keratoconus (29 eyes), corneal scarring from ocular trauma (16), ocular surface disease (25) and post-keratitis corneal scar (two). Patients wore the miniscleral lens for an average of 10 hours per day.

The average uncorrected VA was 1.2logMAR, and the mean difference between best-correct VA with the miniscleral lens and best spectacle-corrected VA was 0.55logMAR. “This significant increase in vision was even seen in those who were referred for the management of ocular surface diseases,” the researchers wrote in their paper.

“Because of the larger diameter, scleral lenses have the advantage of being easier to insert and remove, compared with soft lenses, according to the experience of caretakers of young children with whom we have worked,” the researchers noted. “To the best of our knowledge, there is no documented evidence that favors restricting the use of this treatment modality for pediatric patients, and clinicians should consider scleral lenses as a practical option for an increasing number and variety of younger patients.”

In addition to correcting a number of visual problems, scleral lenses also empower children when it comes to physical activity and self-esteem, both of which are “among major advantages of fitting the pediatric population with scleral lenses,” the study authors wrote in their paper.

“When it comes to therapeutic issues, age should be considered only a barrier to be overcome instead of a contraindication criterion,” they concluded. “Therefore, the concept of ‘dual patient,’ which means parents’ or caregivers’ socioeconomic situation and compliance, is as crucial as patient characteristics and should be considered as a chief priority when fitting children with contact lenses.”

Alipour F, Gohari SJ, Azad N, et al. Miniscleral contact lens in pediatric age group: indications, safety, and efficacy. Eye Contact Lens. May 12, 2021. [Epub ahead of print].