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More DMEK in Vitrectomized Eyes: Successes, Setbacks IN BRIEF |
Check Out More Articles from the January Issue of RCCL Here! |
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| Have a topic you want to see discussed? Want to comment on an article? We want to hear from you! Contact us with your feedback and suggestions. |
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| 1. The fitting goals for all scleral lenses share three characteristics. The lens should (1) land on the conjunctiva overlying the sclera without causing excessive tissue compression or vascular blanching, (2) completely and measurably vault the cornea and limbus, and (3) exhibit minimal vertical or lateral movement on the blink. More
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| 2. Improve patients’ opinions of your practice and increase your productivity by educating your staff on scleral lenses, which will allow them to better recommend scleral lens options and answer some questions before the patient even sits in your chair. More | ||
| 3. Fluorescein, used to define the fluid reservoir during the fitting process, can either be applied to the ocular surface directly or placed in the bowl of the lens prior to application. The former will reduce the risk of staining clothing or fingers during lens application, however. More | ||
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| 5. Providing new scleral lens wearers with adequate information on lens care and demonstrating a variety of insertion and removal methods can dramatically reduce patient dropout by bypassing common reasons for abandonment, such as difficulty with lens handling. More
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| 6. If you’re uncertain of which lens to select during the diagnostic fit, err on the side of greater sagittal depth. It is much easier to estimate the amount of additional sagittal depth required to clear the cornea in a lens that fits with considerable corneal touch. More |
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| 7. When fitting a dry eye patient, start with sclerals designed for the regular/normal cornea, since it’s unlikely you will need the size or geometry that sclerals offer for fitting irregular corneas. But make sure to completely vault the cornea to avoid bearing on a surface that can be mildly compromised secondary to dryness.
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| 8. Offering a scleral lens consult to your post-refractive surgery patients at routine exams can help grow your scleral patient base. Many are unaware there are contact lens options for them—this is especially true of early adopters who underwent refractive surgery using outdated techniques like radial keratotomy.
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| 9. A diagnostic scleral lens fitting set, a trial lens set, a slit lamp and a phoropter—along with careful observation and evaluation—can provide all of the information necessary to successfully fit sclerals. Diagnostic lenses will allow you to assess the fit and over-refraction with either handheld trial lenses or a phoropter will provide the refractive information you need to order the lens. More | ||
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| 11. It isn’t necessary to become familiar with all scleral designs, but have on hand at least two fitting sets—one for one larger (17.0mm to 18.0mm) and one for smaller (15.0mm to 16.00mm) designs. This will cover most indications. More | ||
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| 12. Evaluate the lens fit immediately following application to determine if there’s too much or too little clearance. Because scleral lenses tend to settle with time, bracket the fit in large intervals until you find a lens that demonstrates approximately 100µm to 150µm more clearance than would be considered ideal, then allow the lens to settle for 20 to 30 minutes before the final evaluation. More | ||
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| 13. If a GP patient suffers regularly from irritation due to environmental foreign bodies, consider switching to a scleral lens. Scleral lenses semi-seal to the eye and, when fit correctly, will not reposition with eye movement or blinking. This improves both comfort and stability, and prevents foreign bodies entrapment. More | ||
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| 15. Increase awareness of your practice by making local optometrists and ophthalmologists aware of your expertise in scleral lens fitting. Many doctors do not offer specialty contact lens services, so forming a relationship with them can be mutually beneficial: they will circulate your name to patients, and if you’re so inclined, you can do the same. More | ||
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| 16. If the patient’s lids cannot be opened widely enough for direct application of the lens, try placing one edge of the lens beneath the upper or lower lid and “folding” or “tipping” it into place. If you need to manipulate the angle of the lens during application, a relatively viscous non-preserved product can help prevent excessive fluid loss and entrapment of air bubbles. More | ||
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| 17. As scleral lenses are still relatively new additions to the market, do not assume complications associated with scleral lens wear are identical to those we see with other lens modalities, and do not assume risk factors for those complications are exactly the same as those that have been identified for other lenses. More | ||
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| 19. Because the increased lens and fluid reservoir thickness of a scleral lens can potentially alter effective lens power, careful refraction over a diagnostic scleral lens is recommended to avoid power calculation errors. Using handheld trial lenses can help minimize the need to calculate power adjusted for vertex distance. More | ||
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| 20. Because scleral lenses fit the sclera, not the cornea, their fit is stable regardless of astigmatic orientation. So, consider sclerals for against-the-rule astigmatism, which can be notoriously hard to fit with corneal GPs. Front surface toricity can also be added to sclerals for lenticular astigmatism; unlike corneal GP lenses, ballasted scleral lenses are stable due to their large diameter and semi-sealed fit. More | ||
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