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Scleral Lens Evolution

In exploring my office’s back storage room, I ran across a scleral lens fitting set from 1946 and thought about the evolution of this lens. This 22mm fenestrated, PMMA scleral set from Calcon Laboratories was part of the storied history of scleral lenses that actually started off being fit for healthy eyes.

In the 40’s and 50’s, these lenses were mostly fit for the wealthy that wanted to get out of glasses and athletes who needed visual precision without worrying about knocking glasses off. The PMMA material left a lot to be desired in terms of oxygen permeability and Sattler’s Veil (corneal edema due to the lenses) would set in after 3-4 hours making the lenses unwearable.

Fast forward to the 2000’s

Scleral lenses had their resurgence in the 2000’s due to high oxygen permeable materials and improved manufacturing techniques.

The primary focus of the early adapters was mostly “train wreck” corneas; keratoconus, corneal transplants and other highly irregular corneas unable to achieve desirable vision and comfort with other traditional lens designs.

As lens designs improved and knowledge of scleral lens fitting expanded, so did the indications. Scleral lenses started to be fit for milder ectatic corneas and even relief from ocular surface disease.

Scleral lenses today

Today the benefits of scleral lens optics and comfort are extending back to healthy eye patients and many labs even produce designs specifically for normal corneas.

Scleral lenses are being used to correct regular refractive error, especially high ametropia, astigmatism and presbyopia, surface dryness and once again athletes looking for great visual performance.

While the risk of cornea edema still needs to be managed, scleral lens can improve the contact lens wearing experience and we are likely to see it continue to grow in the contact lens market.

 

Justine Siergey
Justine L. Siergey, OD, FSLS is a private practice optometrist and specialty contact lens fitter in Orlando, Florida. She lectures extensively on scleral contact lenses and other specialty fittings and is a fellow of the Scleral Lens Education Society.

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