The popularity and usability of scleral lenses have been making strides in recent years. Miniscleral design  lenses are perfect for difficult-to-fit eyes due to their larger size, and are even friendly enough to use for your pediatric patients who more commonly lack cooperation and responsibility in self-management. Now, children as young as four may be able to use these vision-saving lenses safely and effectively for various corneal irregularities and ocular surface disorders. 

A recent study observed the charts of 52 pediatric patients (a total of 72 eyes) who were fitted for miniscleral lenses between 2010 and 2019 (mean age 13). Reasons for the lens choice included keratoconus (29 eyes), corneal scarring from ocular trauma (16 eyes), ocular surface diseases (25 eyes) and post-keratitis corneal scar. The following data were observed:

• Uncorrected visual acuity (UCVA)

• Best spectacle-corrected visual acuity (BSCVA)

• Best-corrected vision with the lens

• Comfortable daily wearing time

• Lens parameters

The mean daily wear time was 10 hours or more for 46% of patients with minisclerals, and another 34% reported a mean of eight hours or more, while 20% reported less than eight hours of wear. On average, UCVA and CCVA improved in children with ocular trauma or ocular surface diseases after the lens fitting. The average UCVA and mean difference between spectacle VA and contact lens VA were statistically significant.

Miniscleral lens fitting “should be considered as an effective therapeutic option in children with severe corneal diseases, such as advanced keratoconus, traumatic corneal scar with or without aphakia or psudophakia, postcorneal graft irregularities, and severe ocular surface diseases, such as SJS, graft versus host disease, and dry eye,” the researchers wrote in their paper.

The authors of the study emphasize that age should be seen as a barrier to overcome and not a criterion for miniscleral lens fitting in pediatric patients. They reference the concept of “dual patient,” meaning that parents’ and caregivers’ compliance and socioeconomic situations must also be factored into the treatment of children with minisclerals.