Patient-Reported Dry Eye Treatment and Burden of Care.

OBJECTIVES: Dry eye is a common condition that can decrease the quality of life. This survey-based study of persons with dry eye investigated self-reported treatments (initial, current), out-of-pocket expenses, time spent on self-management, sources of care, and sources of information about their condition. METHODS: Online dry eye newsletters and support groups were emailed a link to an electronic survey asking members to participate. Survey respondents were not required to answer every question. RESULTS: In total, 639 persons with self-reported dry eye responded (86% women, 14% men [n=623]; mean ± SD age, 55 ± 14 years [n=595]). Artificial tears were the most reported intervention (76% initially, 71% currently). The median (interquartile range) out-of-pocket treatment cost annually was $500 ($200-$1,320 [n=506]). In addition, 55% (n=544) estimated 5 to 20 min daily on self-management; 22% spent an hour or more. Ophthalmologists provided most dry eye care (67%, n=520). Only 48% (n=524) reported that their primary source of dry eye information came from their eye care clinician. CONCLUSIONS: Artificial tears are the primary treatment for dry eye. Ophthalmologists provide most dry eye care, but half of patients report that their eye care provider is not their primary source of information. Almost one fourth of patients spend an hour or more daily on treatments.

Graduating optometry student perceptions of their scleral lens fitting knowledge.

Although optometric programs have incorporated scleral lens (SL) education into their curricula, actual student experiences with SL fitting varies widely. This survey study describes the SL fitting and training experiences of graduating optometry students in US schools and colleges. Participants (323) were fourth-year students preparing to graduate in 2020 (19% response rate). Students appeared to have insufficient SL fitting practice, the median number of SL evaluations completed before graduation was 5 (range 0-110) and 63% reported less than 10 fits. Students with an interest in fitting SLs may wish to pursue additional training opportunities, such as residency, to acquire further experience before achieving sufficient proficiency with SLs.

Survey-Based Estimation of Corneal Complications Associated with Scleral Lens Wear.

ABSTRACT: The benefits of scleral lens (SL) wear have been described in cross-sectional and retrospective studies; however, the frequency of complications associated with SL wear has not, to the best of our knowledge, been determined. From a survey of SL practitioners, we estimated the period prevalence over 1 year of corneal complications that required SL wearers to discontinue lens wear. In a sample of 72,605 wearers, SL wear was discontinued for the following complications: corneal edema, 1.2%; corneal neovascularization, 0.53%; microbial keratitis, 0.45%; and limbal stem cell deficiency, 0.20%. This study design allowed for calculation of period prevalence of these complications rather than complication incidence rates. Information presented in this report may be useful in clinical decision-making and for future study design.

Current Trends in Scleral Lens Prescription, Management, and Evaluation.

OBJECTIVES: To report current trends in scleral contact lens prescription and management, including lens designs prescribed, care products recommended, and procedures performed during routine scleral lens (SL) evaluation. METHODS: An online survey was designed by the Scleral Lenses in Current Ophthalmic Practice Evaluation study team and administered to eye care practitioners attending a specialty contact lens meeting. The survey was available from November 8, 2019, through March 31, 2020. Participants' demographic data were collected, along with information on lens diameters, landing zone (LZ) designs, recommended care products, and components of routine SL evaluation. RESULTS: In total, 715 participants responded to at least one of the survey items of interest. Most lenses prescribed (63%) were 16 mm or more in diameter. Lenses with toric LZs were the most frequently prescribed (48%), followed by spherical (40%), quadrant-specific (8%), and impression-based or image-based designs (3%). Most participants (61%) recommended hydrogen peroxide products for lens care. Nonpreserved saline in a single-use vial was most frequently recommended to fill the bowl of the lens before application. Intraocular pressure was measured during SL evaluation by 45% of participants; 38% of participants routinely measured corneal thickness. CONCLUSIONS: Practitioners increasingly are prescribing SLs with advanced LZ designs. Most practitioners recommend hydrogen peroxide-based disinfection systems and single-use vials of nonpreserved saline for lens care and application. Because differences in components of routine SL evaluations were reported, clinicians may benefit from reaching a consensus on essential components of SL evaluation.

Scleral lens prescription and management practices: Emerging consensus.

PURPOSE: To describe international scleral lens prescription and management practices across multiple practice types. METHODS: For this cross-sectional study, scleral lens practitioners were asked to complete an electronic survey that requested information about a single scleral lens patient. Data collected included practitioner demographics (practice type, country, years of experience) and patient indications for scleral lens wear, fitting process, lens design, and care products. RESULTS: Data were collected for 259 patients (419 eyes). Most participants (60%) practiced in the US, 75% worked primarily in community practice, and 58% claimed more than 5 years' experience fitting scleral lenses. Indications for scleral lens wear were corneal irregularity (87%), ocular surface disease (9%), and uncomplicated refractive error (4%). During the fitting process, the mean (SD) number of lenses ordered was 2.4 (1.6) (range, 1-16 lenses) during 3.8 (2.4) visits (range, 1-18 visits). Of patients, 62% used a daily surfactant cleaner, 47% used hydrogen peroxide disinfection, and 67% used single-use vials of nonpreserved saline. Mean lens diameter was 16.2 (1.1) mm (range, 11.8-23.0 mm). The landing zones were spherical (64%), toric (26%), quadrant-specific (7%), and custom (3%) designs. Optical power was spherical in 70%, toric in 27%, and higher-order aberration correcting in 3% of lenses. Only 5 lenses had multifocal optics. CONCLUSIONS: General consensus regarding prescribing patterns (lens design, wearing schedules, care products) between US vs non-US, community vs academic, and new vs established providers is reported in this study. Relatively low percentages of patients wearing lenses with advanced landing zones or optical designs suggest that these new options have not been widely adopted.

Trends in Scleral Lens Fitting Practices: 2020 Scleral Lenses in Current Ophthalmic Practice Evaluation Survey.

OBJECTIVES: To explore trends in demographic characteristics of scleral lens (SL) practitioners and primary indications for SL fitting over 5 years. METHODS: An online survey similar to the 2015 Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) study was designed and administered from November 8, 2019, through March 31, 2020, to attendees at two international contact lens meetings, members of the Scleral Lens Education Society, and participants in the 2015 SCOPE study. Practitioners reporting at least five completed SL fits were included in the analysis. RESULTS: Of 922 respondents, 777 had fit at least five SLs: 63% from the United States (59 other countries were represented), findings similar to the 2015 survey, in which 799 respondents (72%) were US-based and 49 from other countries. Most practitioners were in community practice (76%) than academic practice (24%). In 2015, 64% were in community practice and 36% in academic practice. A median of 84% of SLs were fit for corneal irregularity, 10% for ocular surface disease, and 2% for uncomplicated refractive error. In comparison, the 2015 indications were 74%, 16%, and 10%, respectively. The median number of fits completed per practitioner was 100 (range, 5-10,000; mean [SD] 284 [717]; n=752). In 2015, the median was 36 (range, 5-3,600; mean [SD] 125 [299]; n=678). CONCLUSIONS: The number of experienced SL practitioners is increasing, as is international representation. Most practitioners practice in community rather than academic settings. SLs continue to be primarily prescribed for corneal irregularity and are rarely used solely for correction of refractive error.

Anatomical and physiological considerations in scleral lens wear: Intraocular pressure.

Intraocular pressure (IOP) is maintained through complex and interrelated systems which control aqueous production and drainage, and it has been suggested that scleral lens (SL) wear may disrupt these vital homeostatic processes. This review provides an overview of anatomical and physiological processes that control IOP, identifies potential effects of SLs on these regulatory mechanisms, and examines studies that have attempted to quantify the effect of SLs on IOP. Lack of access to the cornea during SL wear makes accurate assessment of IOP challenging; therefore, a range of different assessment techniques and instruments have been employed to quantify IOP during and following SL wear. Some studies have evaluated IOP using standard techniques prior to lens application and following lens removal, or through a large central fenestration. Other studies have utilised instruments that facilitate assessment of IOP on the peripheral cornea or conjunctiva overlying the sclera (e.g. Schiotz, transpalpebral, and pneumatonometry). Two studies have recently evaluated changes in optic nerve structure during SL wear. Conflicting results have been reported on this topic, much of which examines changes in IOP in healthy subjects over limited periods of time. Currently, only a few studies have reported on long-term effects of SL wear on IOP in habitual SL wearers (after lens removal). Future research in this area must not only consider the fact that ocular conditions treated with SLs may potentially alter corneal biomechanical properties which can influence IOP, but also that these properties may be further altered by SL wear. Monitoring other risk factors for glaucoma (permanent alterations in optic nerve physiology, visual field defects) could provide a more comprehensive assessment of potentially increased risk of glaucomatous optic neuropathy due to SL wear. Ongoing clinical assessment of optic nerve structure and function is advisable in patients at risk for glaucoma who require SLs.

Tear Exchange, Intraocular Pressure, and Wear Characteristics of Quadrant-specific Versus Spherical Haptic Scleral Lenses.

OBJECTIVES: To compare scleral lenses (SLs) with a quadrant-specific (study lens) or a spherical (habitual lens) landing zone in a crossover study. METHODS: Seven participants (eight eyes) wore each of two lenses for 2 weeks before measurements. We measured visual acuity, contrast sensitivity, intraocular pressure (IOP), fluid reservoir clearance, corneal thickness, tear exchange, and lens experience. Variables were compared between lenses and before and after 2 hr of wear. RESULTS: The visual acuity was not different between the study lens, 0.12 logarithm of the minimum angle of resolution (logMAR), and habitual lens, 0.18 logMAR (median, P = 1.0). Contrast sensitivity was 1.3% under the study lens and 1.6% under the habitual lens ( P = 0.94). IOP did not change after 2 hr of wear for either lens (study lens, P = 0.33 and habitual lens, P = 0.74), and corneal thickness did not change during wear of either lens ( P = 0.44). The fluorescein concentration under the study lens did not change after 2 hr (99% of initial concentration; P = 0.84) but decreased to 46% of initial concentration under the habitual lens ( P = 0.008). Lens comfort was slightly better with the study lens (5.0 vs. 4.0, respectively; P = 0.05). CONCLUSIONS: SLs with spherical or quadrant-specific landing zones provide good vision and do not affect IOP or corneal thickness. However, tear exchange is greater under spherical lenses than under quadrant-specific lenses. The quadrant-specific lens provides greater patient comfort.

Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series.

OBJECTIVES: To report on microbial keratitis (MK) in three scleral lens (SL) wearers who had undergone penetrating keratoplasty (PKP). METHODS: This retrospective case series describes 3 cases of MK in patients who wore SLs after PKP. RESULTS: All three patients wore SLs for visual rehabilitation for corneal irregularity induced by PKP; all three also had concurrent ocular surface disease (keratoconjunctivitis sicca and corneal exposure). Cultures identified the causative organism in two patients, and septated hyphae suggestive of fungal infection were identified in tissue removed during therapeutic PKP in the third patient. All three patients were receiving either topical or systemic immunosuppressive therapy before the infection developed. CONCLUSIONS: Scleral lenses are often used to manage complex ocular disease, which can make it difficult to determine the precise cause of complications that arise after wearing the lenses. Multiple factors, including SL wear, may have contributed to the initial development of MK in the three patients in this case series. Patients who wear SLs after PKP should be monitored closely.

Quadrant-Specific Changes in Corneal and Tear Fluid Reservoir Thickness for After 2 Hours of Wear.

OBJECTIVE: To measure corneal swelling and thickness of the tear fluid reservoir (TFR) after wearing scleral lenses (SLs). METHODS: Thirty-five participants had 1 eye fitted with each of three SLs (15.0-mm Jupiter, 18.2-mm Jupiter, and 18.0-mm Digiform). Scheimpflug images were obtained before wear, after application, after 2 hr of wear, and after removal. Initial and final TFR thickness and corneal thickness were measured in the central cornea and 3 mm from the center in the superior, inferior, temporal, and nasal quadrants. RESULTS: Corneal thickness increased with wear, but no between-lens differences were observed in the superior (P=0.09), inferior (P=0.38), or temporal (P=0.53) quadrants. The greatest change in central and nasal cornea thickness was with the 15.0-mm SL (P<0.001). All areas showed settling, with no between-lens differences. Greater final TFR thickness was noted for the superior and nasal quadrants with the 18.0-mm SL (P<0.001), and less final TFR thickness was noted in the inferior (P<0.001) and temporal (P<0.001) quadrants with the 15.0-mm SL. Corneal thickness was not associated with the final TFR thickness. CONCLUSIONS: The greatest corneal swelling was observed in the inferior quadrant with the 15.0-mm SL, although this lens had the least TFR thickness inferiorly. TFR thickness alone did not account for observed corneal swelling.

Anatomical and physiological considerations in scleral lens wear: Eyelids and tear film.

Scleral lenses can affect a range of anterior segment structures including the eyelids and the tears. The eyelids, consisting of the outer skin layer, the middle tarsal plate, and the posterior palpebral conjunctiva, provide physical protection and house the meibomian glands and cilia which have important and unique functions. Tears consist of a mix of aqueous, mucus, and lipidomic components that serve vital functions of lubricity, protection, and nourishment to the ocular surface. Both the eyelids and the tear film interact directly with scleral lenses on the eye and can affect but also be impacted by scleral lens wear. The purpose of this paper is to review the anatomy and physiology of the eyelids and tear film, discuss the effects and impacts of the scleral lenses on these structures, and identify areas that require further research.

Clinical Outcomes of Scleral Lens Fitting with a Data-driven, Quadrant-specific Design: Multicenter Review.

SIGNIFICANCE: Alignment of the scleral lens haptic with the anterior ocular surface is of critical importance when fitting scleral lenses. The concept of leveraging big-data analysis to drive lens design is explored in this study. This retrospective study evaluated fitting outcomes of a data-driven, quadrant-specific scleral lens design and found that most patients (76%) were successfully fit with this design. PURPOSE: The purpose of this study was to evaluate clinical outcomes with a data-driven, quadrant-specific scleral lens design compared with traditional lens designs. METHODS: For this multicenter retrospective observational study, A REDCap (Research Electronic Data Capture) survey was distributed to scleral lens practitioners who participated in ß testing of a data-driven, quadrant-specific scleral lens design (study lens) between June 1, 2016, and January 31, 2017. Descriptive data were collected, and patient-reported outcomes, visual acuity, and lens design outcomes achieved with the study lens were described. RESULTS: Seventy-five patients (85 eyes) were fit with the study lens design between June 2016 and January 2017. Mean patient age was 47 years (range, 17 to 77 years). Forty-six were male, and 29 were female. Seventy-six eyes (89%) were fit for corneal irregularity, whereas nine eyes (11%) were fit for management of ocular surface disease. Compared with habitual correction, 22% more eyes achieved 20/20 or better, and 21% more eyes achieved 20/40 or better. There was also a 60% decrease in the need for midday removal with the study lens. An average of two lenses were manufactured per eye to complete the fitting process. CONCLUSIONS: Using a data-driven, quadrant-specific scleral lens resulted in visual improvement, a reduced need for midday removal, and an average of two lenses needed to complete the fitting process. Longer-term clinical outcomes and the use of big-data analysis to inform scleral lens design should be further explored.

Anatomical and physiological considerations in scleral lens wear: Conjunctiva and sclera.

While scleral lenses have been fitted using diagnostic lenses or impression moulding techniques for over a century, recent advances in anterior segment imaging such as optical coherence tomography and corneo-scleral profilometry have significantly improved the current understanding of the anatomy of the anterior eye including the morphometry of the conjunctiva, sclera, and corneo-scleral junction, as well as the ocular surface shape and elevation. These technological advances in ocular imaging along with continual improvements and innovations in scleral lens design and manufacturing have led to a global increase in scleral lens prescribing. This review provides a comprehensive overview of the conjunctiva and sclera in the context of modern scleral lens practice, including anatomical variations in healthy and diseased eyes, the physiological impact of scleral lens wear, potential fitting challenges, and current approaches to lens modifications in order to minimise lens-induced complications and adverse ocular effects. Specific topics requiring further research are also discussed.

Factors associated with patient-reported midday fogging in established scleral lens wearers.

PURPOSE: To estimate the prevalence of patient-reported midday fogging and to identify risk factors for midday fogging. METHOD: A multicenter, cross-sectional study was conducted with an electronic survey that was distributed to scleral lens practitioners. The survey asked them to describe their most recently examined established scleral lens patient. Respondents provided data about patient-reported midday fogging, patient demographic characteristics, indication for lens wear, lens-wearing schedule, lens design, and care products. RESULTS: Of the 248 survey respondents who indicated whether their patients had midday fogging, 64 (25.8 %) had patients who self-reported such issues. Midday fogging was not associated with demographic characteristics (age, sex, race/ethnicity), indications for scleral lens wear, mean lens diameter (P = .30), haptic design (P = .29), use of a daily cleaner (P = .12), disinfection/storage solution used (P = .71), or filling solution (P = .65). Patients who reported midday fogging more commonly reported redness or irritation associated with scleral lens wear compared with those who did not experience midday fogging (P = .03). CONCLUSIONS: Prevalence of midday fogging in this study was similar to previously reported rates. No specific lens design or care product was associated with patient-reported midday fogging. If inflammatory mediators are elevated in the postlens fluid reservoir of patients with midday fogging, as previously described, the redness or irritation associated with scleral lens wear suggests that ocular surface inflammation may be contributing to this phenomenon.

Telemedicine in long-term care of glaucoma patients.

Introduction: This manuscript describes data from an original study, simulating a tele-glaucoma programme in an established clinic practice with an interdisciplinary team. This is a 'real life' trial of a telemedicine approach to see a follow-up patient. The goal is to evaluate the accuracy of such a programme to detect worsening and/or unstable disease. Such a programme is attractive since in-clinic time could be reduced for both the patient and provider. This study evaluates agreement between in-person and remote assessment of glaucoma progression. Methods: A total of 200 adult glaucoma patients were enrolled at a single institution. The in-person assessment by an optometrist or glaucoma specialist at time of enrolment was used as the gold standard for defining progression. Collated clinical data were then reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrolment visit to data from the visit immediately prior to enrolment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to remote assessment when both assessments were performed by the same provider (n = 279 eyes). Results: A total of 399 eyes in 200 subjects were analysed. Agreement between in-person versus remote assessment for the determination of glaucoma progression was 63%, 62%, 69% and 68% for each reader 1­4 (kappa values = 0.19, 0.20, 0.35 and 0.33, respectively). For intra-observer agreement, reader 1 agreed with their own in-person assessment for 65% of visits (kappa = 0.18). Discussion: Intra-observer agreement was similar to the agreement for each provider who did not see the patient in person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and remote assessments. However, fair agreement levels highlight a limitation of using only telemedicine data to determine progression compared with clinical detail available during in-patient assessment.

Scleral lens fitting and assessment strategies.

PURPOSE: To describe prescriber reported scleral lens fitting and assessment strategies. METHODS: The SCOPE (Scleral Lenses in Current Ophthalmic Practice Evaluation) study group designed and administered an IRB approved, electronic survey (REDCap) regarding current scleral lens fitting and assessment methods. The survey was distributed to attendees of the 2017 Global Specialty Lens Symposium. RESULTS: 95 practitioners responded to the survey. Over half of the respondents, 58% (55/95) reported fitting scleral lenses for less than five years (new prescribers), and 42% (40/95) reported fitting scleral lenses for more than five years (experienced prescribers). There was a statistically significant difference between their initial use of technology (χ2 = 21.117, p < 0.0005) in selection of a diagnostic lens. New prescribers consider base curve first (60%, 33/55), while experienced prescribers considered sagittal depth first (63%, 25/40) in their initial scleral lens selection. All of the experienced lens prescribers (100%, 39/39) reported estimating central clearance by comparing thickness of the post-lens tear reservoir to scleral lens thickness using a slit lamp beam at least some of the time, and 62% of new scleral lens prescribers (34/55; χ2 = 19.175, p < 0.0005) reported doing so. All (100%, 40/40) experienced prescribers schedule scleral lens follow-ups at a specific time and assess conjunctival compression (100%, 40/40), conjunctival staining (100%, 39/39), and corneal staining (100%,40/40) after lens removal. CONCLUSIONS: Practitioners with varying backgrounds and experience have added sclerals to their lens inventories. However, definite guidelines for fitting have not been developed. The results of a survey are provided; demonstrating that among practitioners with greater than 5 years of scleral lens experience, a consensus has emerged for best practices. Strategies for lens evaluation, which may inform future efforts at generating scleral fitting standards are described.

Changes in Optical Density of Postlens Fluid Reservoir During 2 Hours of Scleral Lens Wear.

OBJECTIVES: Debris accumulation in the postlens fluid reservoir during scleral lens wear is clinically observed. We evaluated a method to quantify increases in turbidity of the postlens fluid reservoir by assessing changes in optical density of the fluid over time and compared these changes during 2 hr of scleral lens wear using three different lens designs. METHODS: Thirty-five patients (age, mean [SD], 29 [7] years) with no history of eye disease were enrolled in the study. Participants were fit with a 15.0-, 18.0-, and 18.2-mm scleral lens on one randomly selected eye during the enrollment examination. During each of three subsequent visits, one of three lenses selected during enrollment was placed on the eye. Scheimpflug images were acquired within 5 min of lens placement and at 20-min intervals for the ensuing 2 hr. Fluid reservoir optical density was assessed using Pentacam (Oculus Inc) analysis software. RESULTS: Increases in fluid reservoir optical density were significant between each time interval with all lenses until 100 min. No significant increases in fluid reservoir optical density were noted with the 15.0- and 18.0-mm lenses between 100 and 120 min; fluid reservoir optical density increased with the 18.2-mm lens between 100 and 120 min. Optical density increased by 105% (15.0-mm lens) and 117% (18.0- and 18.2-mm lenses) at 2 hr. CONCLUSIONS: Optical density of the postlens fluid reservoir can be quantified during scleral lens wear. During 2 hr of wear, fluid reservoir optical density doubled with all lens designs evaluated.

Scleral Lens Prescription and Management Practices: The SCOPE Study.

OBJECTIVES: To assess current scleral lens prescription and management practices by conducting an international online survey of eye care providers. METHODS: The SCOPE (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) study group designed and administered an online survey regarding current scleral lens prescription and management practices. The survey was open from January 15 to March 31, 2015, and generated 723 responses from individuals who had fit at least 5 patients with scleral lenses. RESULTS: Respondents (n=663) prescribed scleral lenses that ranged from 15 to 17 mm in diameter (65%), smaller than 15 mm (18%), and larger than 18 mm (17%). More than 50 lens designs were identified. Average daily wearing time of 11.8 hr was consistent across 651 respondents, and 475/651 (73%) recommended midday removal on some, most, or all days. Most respondents recommended nonpreserved saline to fill the bowl of the lens before application (single-use vials, 392/653 [60%]; bottled products, 372/653 [57%]). A hydrogen peroxide-based disinfection system was the most commonly recommended care product (397/651 [61%]). CONCLUSIONS: A reasonable degree of consensus exists regarding some aspects of scleral lens prescription and management (average lens diameter, daily wearing time, and use of nonpreserved products for lens application). Further study is needed to develop evidence-based guidelines for scleral lens prescription and management.

Demographic Characteristics and Prescribing Patterns of Scleral Lens Fitters: The SCOPE Study.

OBJECTIVES: This study reports demographic characteristics of scleral lens providers and indications for scleral lens prescription as assessed by a worldwide online survey. METHODS: The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group designed the online survey regarding current scleral lens prescription and management practices. The Mayo Clinic Survey Research Center administered the survey, which was open from January 15 to March 31, 2015. Data from 989 responses were collated by the Survey Research Center and deidentified before analysis. Responses of individuals who had fit at least five patients with scleral lenses were analyzed in detail. RESULTS: Most lens fitters were men (61%, n=800). Of survey respondents, 29% were 25 to 34 years; 22%, 35 to 44 years; 22%, 45 to 54 years; and 26%, more than 55 years (n=806). For 29% of all respondents, professional training was completed between 2009 and 2014 (n=804). Most (54%) fit their first patient between 2010 and 2015, with the earliest lens fit reported in 1956 (n=634). Most respondents (63%) worked primarily in private, group, or retail practice (n=811). Scleral lenses were most often prescribed for corneal irregularity (74%), followed by ocular surface disease (16%) and uncomplicated refractive error (10%) (n=673). CONCLUSIONS: Eye care providers of all ages are fitting scleral lenses. The number of individuals who fit this lens modality has increased during the past decade. Scleral lenses are being fit by providers in a wide range of practice settings. Most scleral lenses are prescribed for corneal irregularity.

Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

PURPOSE: To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. METHODS: The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. RESULTS: Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. CONCLUSION: Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.