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    Considering scleral lenses for astigmatic patients


    A multicenter, prospective, cross-over study that compared patient satisfaction outcomes between a soft toric lens design and a large-diameter GP lens design found that patients subjectively report better acuity while using a computer and performing other near tasks when wearing prescribed large diameter GP lenses.11 Therefore, it is foreseeable that even a single vision scleral lens design may potentially help to defer the need for multifocal optics.

    Nonetheless, for presbyopic patients who require more accommodative assistance, multifocal scleral lenses are becoming a great clinical addition to our optometric armamentarium. Not only can scleral lenses help these patients who often have concomitant dry eye, there are numerous multifocal scleral lens options that provide exceptional vision across multiple visual ranges.16 Aspheric, center distance and center near designs are just a few of the multifocal lens options (Figures 5A, 5B; Figure 6).

    Because scleral lenses protect and bathe the ocular surface, they are fantastic for patients who have been clinically diagnosed with dry eyes and/or have suffered poor on-eye contact lens performance related to their tear deficiencies. As the patient profile complexity increases, scleral lens designs become exceedingly one of the first treatment options for us to recommend to patients. Therefore, it is no wonder that one of our top indications for scleral lens in healthy eyes is a patient with astigmatism, presbyopia, and dry eye.

    Moving into sclerals

    Today’s scleral lenses are an ideal way to expand a contact lens practice. Start with your existing patients with normal, healthy eyes, especially when vision, comfort, or both are suboptimal with patients’ habitual contact lens modalities. Educate these patients on the benefits and risks of scleral lenses and help them set proper expectations with regards to the scleral lens fitting process.

    You can offer this incredible technology to patients with astigmatism, athletic demands, dry eyes, allergies, presbyopia, or simply to improve vision and/or comfort compared to their habitual contact lenses.

    Many professional resources exist to help clinicians obtain the latest developments in this field, including The Scleral Lens Education Society (www.sclerallens.org) and International Keratoconus Academy (www.keratoconusacademy.com).


    Whether patients have regular corneas or existing corneal pathologies, scleral lenses can positively impact the lives of many of our patients. And in return, our optometric profession will be enriched with the satisfaction of delivering the best care that our patients deserve.



    1. Visser ES, Wisse RP, Soeters N, Imhof SM, Van der Lelij A. Objective and subjective evaluation of the performance of medical contact lenses fitted using a contact lens selection algorithm. Cont Lens Anterior Eye. 2016 Aug;39(4):298-306.

    2. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: A survey. Int Contact Lens Clin. 1999 Nov;26(6):157-162.

    3. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002 Nov;22(6):516-27.

    4. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007 Feb;26(2):168-74.

    5. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Rev Optom. 2010;147(11):37-42. 

    6. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013 Jan;39(1):93-99.

    7. Brujic M, Miller, J. Minimizing Dropouts: What You Can Do. Rev Cornea Contact Lens. Available at: http://www.reviewofcontactlenses.com/content/c/27244/. Accessed 9/19/17.

    8. Nichols JJ, Willcox MD, Bron AJ, Belmonte C, Ciolino JB, Craig JP, Dogru M, Foulks GN, Jones L, Nelson JD, Nichols KK, Purslow C, Schaumberg DA, Stapleton F, Sullivan DA; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: executive summary. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS7-TFOS13

    9. MciIlraith R, Young G, Hunt C. Toric lens orientation and visual acuity in non standard conditions. Cont Lens Ant Eye. 2010 Feb;33(1):23-26.

    10. Michaud L. Scleral Lens Fitting: Once Rare, Now Routine? Rev Cornea Contact Lens. Available at: https://www.reviewofoptometry.com/ce/scleral-lens-fitting-once-rare. Accessed 9/19/17.

    11. Michaud L, Bennett ES, Woo SL, Reeder R, Morgan BW, Dinardo A, Harthan JS. Clinical Evaluation of Large Diameter Rigid-Gas Permeable Versus Soft Toric Contact Lenses for the Correction of Refractive Astigmatism. A MultiCenter Study. Eye Contact Lens. 2016 Nov 24. [Epub ahead of print]

    12. Allergy Facts. American College of Allergy, Asthma, and Immunology. Available at:

    http://acaai.org/news/facts-statistics/allergies. Accessed 6/12/17.

    13. Urgacz A, Mrukwa E, Gawlik R. Adverse events in allergy sufferers wearing contact lenses. Postepy Dermatol Alergol. 2015 Jun;32(3):204-9.

    14. Vance KD. Miller W. Bermangson J. Measurement of tear flow in scleral contact lens wearers. Poster presented at American Academy of Optometry annual meeting, October 7-10, 2015, New Orleans.

    15. Michaud L, van der Worp E, Brazeau D, Warde R, Glasson CJ. Predicting estimates of oxygen transmissibility for scleral lenses. Cont Lens Anterior Eye. 2012 Dec;35(6):266-71.

    16. Barnett M. Multifocal Scleral lenses. Contact Lens Spectrum. Available at: https://www.clspectrum.com/issues/2015/december-2015/multifocal-scleral-lenses. Accessed 9/1/9/17. 

    Clark Y. Chang, OD, MSA, MSc, FAAO
    Dr. Chang is a subinvestigator in numerous clinical trials. He is immediate past president of New Jersey Academy of Optometry, and an ...


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