Frugal Method of Notch Modification of Scleral Contact Lenses in the Setting of Complex Ocular Surface Anatomy.

ABSTRACT: Scleral contact lenses (ScCLs) have gained popularity as a treatment of refractive errors in patients with complex anterior segment pathology. Patients with mechanical abnormalities of the ocular surface may be unsuccessful with traditional ScCL fitting. Scleral contact lens modifications, such as notching and microvaulting, typically incur additional financial costs and require the services of professional laboratories. We describe a frugal method of ScCL notch modification that can be performed by a practitioner using readily available tools in a single office visit. Two patients with abnormal ocular surface anatomy were fit with the practitioner-modified ScCL and achieved successful visual rehabilitation. We offer this method as a potentially economical and effective technique to achieve successful ScCL fitting in this challenging patient population with pathologies that may preclude standard ScCL usage.

Progression From Soft Lens to Piggyback Soft-Scleral Contact Lens System to Facilitate Scleral Lens Use in a Pediatric Patient.

ABSTRACT: Traumatic injury in the pediatric population often results in significant refractive errors that if left untreated can lead to amblyopia. Scleral contact lenses (ScCLs) have recently gained popularity in this population for efficacy in treatment of significant refractive errors, including irregularity astigmatism and corneal abnormalities. Scleral contact lens intolerance may limit the ability of practitioners to use this modality. Although a soft contact lens (SCL) is generally well tolerated, it cannot treat refractive error as effectively as an ScCL. We recently used an SCL followed by an SCL-ScCL combination ("piggyback" system) sequence in a pediatric patient to facilitate use of an ScCL alone. We hope that our results may provide practitioners with an additional option when treating this challenging patient population.