Over the past 10-15 years, the use of scleral lenses has dramatically increased due to the improvement in comfort and visual stability that the lenses provide, as well as the development of improved and easier-to-fit designs. Therapeutic optometrists and ophthalmologists use these medical devices for individuals suffering from irregular corneal astigmatism and in ocular surface diseases. As many as 25% of practitioners believe that the lens modality has emerged as a reasonable option for normal eyes which consists of more than 38 million contact lens wearers worldwide.
With the expansion of scleral lens use comes the need and opportunity to understand and communicate effectively regarding their safety and efficacy. Safety profiles of scleral lenses have begun to be established, but a critical benchmark to contact lens safety, established for all other types of contact lenses, is still missing from the literature: the incidence of microbial keratitis (MK). In the past several years, reports of MK have indeed emerged, although they exist only as case reports and no full-scale investigation into risk factors/confounding variables has been done.
The Consortium of Researchers Investigating Sclerals (CoRIS) is a group of practitioners who came together at GSLS 2020, who have established a mission to answer ‘big picture’ questions about scleral lenses that require a large dataset from a variety of diverse practices and demographics. At this first meeting in 2020, it was decided that the incidence of MK in scleral lenses, while expected to be low (specific estimate is 15-20 per 10,000 patient-years), is an essential metric to contribute to the safety profile of the lenses. The Multicenter Collection of Scleral Lens Outcomes (MC-SLO) study has been designed by members of the CoRIS group over the past two years, and funding to answer this question was obtained through the 2022 Clinical Research Award ($100,000) from the American Academy of Optometry.
1. Fuller D, Wang Y. Safety and efficacy of scleral lenses for keratoconus. Optometry & Vision Science. 2020;97(9):741-748.
2. Yan P, Kapasi M, Conlon R, et al. Patient comfort and visual outcomes of mini-scleral contact lenses. Canadian Journal of Ophthalmology.2017;52(1):69-73.
3. Bergmanson JP, Walker MK, Johnson LA. Assessing scleral contact lens satisfaction in a keratoconus population. Optometry and Vision Science.2016;93(8):855-860.
4. Ortenberg I, Behrman S, Geraisy W, Barequet IS. Wearing time as a measure of success of scleral lenses for patients with irregular astigmatism. Eye& Contact Lens. 2013;39(6):381-384.
5. Schornack M, Patel S. Scleral lenses in the management of keratoconus. Eye & Contact Lens. 2010;36(1):39-44.
6. Koppen C, Kreps EO, Anthonissen L, van Hoey M, Dhubhghaill SN, Vermeulen L. Scleral lenses reduce the need for corneal transplants in severekeratoconus. American Journal of Ophthalmology. 2018;Jan(185):43-47.
7. Dalton K, Sorbara L. Fitting an MSD rigid CL in advanced keratoconus with INTACS. Contact Lens & Anterior Eye. 2011;34(6):274-281.
8. Magro L, Gauthier J, Richet M, et al. Scleral lenses for severe chronic GvHD-related keratoconjunctivitis sicca: A retrospective study by the SFGM-TC. Bone Marrow Transplantation. 2017;52(6):878-882.
9. Takahide K, Parker PM, Wu M, et al. Use of fluid-ventilated, gas-permeable scleral lens for management of severe keratoconjunctivitis siccasecondary to chronic graft-versus-host disease. Biology of Blood and Marrow Transplantation. 2007;13(9):1016-1021.
10. Kok JH, Visser R. Treatment of ocular surface disorders and dry eyes with high GP scleral lenses. Cornea. 1992;11(6):518-522.
11. Bavinger J, DeLoss K, Mian S. Scleral lens use in dry eye syndrome. Current Opinion in Ophthalmology. 2015;26(4):319-324.
12. Alipour F, Kheirkhah A, Jabarvand Behrouz M. Use of mini SL in moderate to severe dry eye. CLAE. 2012;35(6):272-276.
13. Jacobs DS, Rosenthal P. Boston scleral lens prosthetic device for treatment of severe DED in GVHD. Cornea. 2007;26(10):1195-1199.
14. Bennett ES. Contact Lens Spectrum - GP Annual Report 2018. Contact Lens Spectrum.
15. Zimmerman AB, Marks A. Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. Eye & ContactLens. 2014;40(1):e1-e4.
16. Fernandes M, Sharma S. Polymicrobial and Microsporidial Keratitis in a Patient using Boston Scleral Contact Lens for Sjogren’s Syndrome andOcular Cicatricial Pemphigoid. Contact Lens and Anterior Eye. 2013;36(2):95-97.
17. Rosenthal P, Cotter JM, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleralcontact lens. American Journal of Ophthalmology. 2000;130(1):33-41.
18. Severinsky B, Behrman S, Frucht-Pery J, Solomon A. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long-termoutcomes. Contact Lens and Anterior Eye. 2014;37(3):196-202.
19. Sticca MP, Carrijo-Carvalho LC, Silva IMB, et al. Acanthamoeba keratitis in patients wearing scleral contact lenses. Contact Lens and Anterior Eye.2018;41(3):307-310.
20. Farhat B, Sutphin JE. Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens. Eye & ContactLens. 2014;40(1):e5-7.
21. Rocha GA do N, Mlziara POB, Viera de Castro AC, Rocha AA do N. Visual rehabilitation using mini-scleral contact lenses after penetratingkeratoplasty. Arquivos Brasileiros de Oftalmologia. 2017;80(1):17-20.