10/9/2014. Basics of Scleral Lens Fitting: Its as Easy as 1-2-3

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1 Basics of Scleral Lens Fitting: Its as Easy as Melissa Barnett, OD, FAAO, FSLS Bruce Baldwin, OD, FAAO, FSLS Michael Lipson, OD, FAAO, FSLS Jason Jedlicka, OD, FAAO, FSLS Mindy Toabe, OD, FAAO, FSLS Bruce Baldwin, OD, FAAO, FSLS University of North Carolina Mindy Toabe OD, FAAO, FSLS Case Western Reserve University Ohio Stat University, School of Optometry Melissa Barnett, OD, FAAO, FSLS University of California, Davis Please silence all mobile devices. Unauthorized recording of this session is prohibited. Jason Jedlicka, OD, FAAO, FSLS Cornea & Contact Lens Institute of Minnesota Michael Lipson, OD, FAAO, FSLS University of Michigan Department of Ophthalmology and Visual Science Kellogg Eye Center Disclosure Statement Dr. Barnett: Alcon, Allergan, Acculens, Alden, GPLI, Nidek, Secretary SLS Dr. Baldwin: Alden, Essilor, SLS Immediate Past President Dr. Jedlicka: Alden Optical, Dakota Sciences, Alcon/Ciba, B+L, GPLI, Paragon, Essilor, Wells Research, Paragon Vision Science, President SLS Dr. Lipson: B+L/Valeant, SLS Treasurer Dr. Toabe: None Basics of Scleral Lens Fitting: Its as Easy as Please complete your session evaluation using EyeMAP online at Tweet about this session using the official meeting hashtag Please silence all mobile devices. Unauthorized recording of this session is prohibited. Polymethylmethacrylate (PMMA), in the early 1900 s Made from impression mold of eye Difficult to make Problem with hypoxia 0ptometrists.org 1

University of California, Davis Please silence all mobile devices. Unauthorized recording of this session is prohibited.

2 Scleral Contact Lens Fitting Principles 18.2mm 9.0mm Scleral Lens Design Scleral Lens Designs Each company s design is somewhat different in the curves fitting method. Highly recommended to use the fitting set, follow the fitting guide for the specific lens design, and utilize consultants to fully understand the specific lens design. Companies have proprietary lens designs Example: Five Curve Lens Base Curve (BC), 8.2mm Width Corneal Curve = BC + 0.4, 2mm W Limbal Curve = 9.0, 1mm W Scleral Curve (Landing) = 12.25, 1.5mm W Edge Curve = 14.5, 0.5mm W FITTING SCLERAL LENSES IS AS EASY AS BRIDGE OVER THE CORNEA 3 2

Highly recommended to use the fitting set, follow the fitting guide for the specific lens design, and utilize consultants to fully understand the specific lens

3 1. Bridge Over The Cornea and Limbus D D Base curve changes can increase VAULT (Clearance, Fluid Chamber) OCT With Corresponding Slit Images Greg DeNaeyer, OD SAG Good Limbal Clearance 3

4 2 2. Landing Not Too Flat Or Steep Landing Aligned with Sclera Landing Aligns With Sclera 3. Adequate Tear Exchange 3 Adequate Tear Flow Under the Lens 4

5 Example of Inadequate Tear Exchange 5 sec 14 min Tight lens periphery 3 min Can manually pump tears under lens, but takes 15 min to fill. Corneal ectasias Primary corneal ectasias Advanced (notably decentered) keratoconus Keratoglobus Pellucid marginal degeneration Post Refractive Surgery Complications Secondary corneal ectasias Post-LASIK Post-PRK Post-RK Epithelial ingrowth Melted flap Severe dry eyes Graft versus host disease Sjogren s syndrome Stevens Johnson syndrome Neurotrophic keratopathy Corneal transplants Trauma Corneal scars Chemical burns Corneal degenerations or dystrophies Salzmann s nodular degeneration Terrien s marginal degeneration Inflammatory conditions Limbal stem cell deficiency Ocular cicatricial pemphigoid 5

ectasias Post-LASIK Post-PRK Post-RK Epithelial ingrowth Melted flap Severe dry eyes Graft versus host disease Sjogren s syndrome Stevens Johnson syndrome Neurotrophic keratopathy

6 Why Use a Larger Lens? Persistent epithelial defects Larger lenses are often needed if cone is decentered inferior, if smaller lenses are uncomfortable, or smaller lenses tend to dislodge. Why Use A Larger Lens? Scleral lenses are often successful for RGP failures and are used for severe keratoconus or when standard RGP are not tolerated. Scleral lens parameters OD: KCN design, PC1 is 4.0 D flatter than BC OS: Reverse geometry design, PC1 will be 4D steeper than the standard parameters Case Report OD: KCN OS: PK Sjögren s Syndrome Sjögren s Syndrome Essilor Jupiter Tyro BC DIA Pwr OZ PC PC PC3 1.5 Apical Clearance 0.5 PC4 0.5 VA OD 20/20 SOR: plano OS 20/70 SOR to 20/20 OU 20/20 J2 AWT: 10 hours, removes and cleans at lunchtime daily Care system: Optimum cleaner and conditioner with Unisol Vascular Impingement Limbal Edema 6

Scleral lens parameters OD: KCN design, PC1 is 4.

7 OD Touch OD Horiz Horiz Horiz Horiz 51.00D, 15.6mm, Flat Centrally Touch Steepened 3D to 54.00D, 15.6mm, Apical Clearance Now 20/50.Has Driver License! Vert Vert 47.00D, 18.2mm, -6.50D, 20/20- Fitting Guides -Fitting Philosophies Fit by: BC / diameter SAG / limbal vault / edge lift SAG / BC / diameter BC / SAG / limbal vault / edge lift Custom with CAD Jupiter MSD, ICD Maxim AVT PROSE Greg DeNaeyer, Review of Cornea and Contact Lens 7

50D, 20/20- Fitting Guides -Fitting Philosophies Fit by: BC / diameter SAG / limbal vault / edge lift SAG / BC / diameter BC /

8 Non-Preserved Saline 0.9% NaCl prescription example It s time to experience and fit scleral lenses! Any questions? 8

Make a difference in someone s life FITTING GUIDE

Make a difference in someone s life FITTING GUIDE CONTENTS Introduction 3 Applications 4 Characteristics 4 Fitting philosophy 5 Mid-peripheral / limbal zone 6 Only 3 fitting variables to determine 7 Ideal