The GSLS poster session was chock full of interesting case reports and other fresh, unique studies on all kinds of scleral lens topics. I'm told I may have violated protocol by taking pictures. Oops. I've taken pictures of posters at ever medical meeting I've ever been to so I could study them later, and I've always seen others doing it. Next time I'll abstain or ask the poster owners first! Meantime, I went through all of the ones that had caught my eye on the flight home, and I've tried to write about them without, hopefully, oversharing in an inappropriate way.
- We are just barely starting to see studies looking at patient-perspective issues such as adapting to lenses, and issues with filling solutions.
- In a more mature area, there were several about challenging RK patients - a trend that's going to go on and on and on as the many RKs from the 80s and 90s continue facing issues.
- The use of scleral lenses as "combination therapy" of sorts, that is, for complex vision issues plus dry eye (which incidentally is how I personally use sclerals).
- Keratoconus as a dominant theme (unsurprisingly, as it seems to be far and away the most common indication for sclerals).
- Various emerging technologies to assist with fitting extra-challenging eyes.
- A fascinating variety of extreme or unusual disease situations where scleral lenses were used, with great care, successfully. Some were for conditions I had never even heard of such as aspergillosis and argyrosis, while others were for used in less-common-but-usual situations, such as chemical burns, radiation, or hydrops.
- Therapeutic use of scleral lenses in patients who had experienced complications from a different type of contact lens, such as neovascularization from a soft lens where the patient went into sclerals as the best way to tolerate a lens that would address their irregular astigmatism.
- Overall, though, I would say there were noticeably fewer than I would have expected on patients where dryness was the primary indication.
"Initial Scleral Contact Lens Wearing Experience (Bickle et al)
This was an excellent poster highlighting the need to better understand the challenges of the early adaptation period for new scleral lens wearers, including ease of learning application and removal techniques, how many visits were required for training, and patient satisfaction rates.
“Management options for pediatric advanced keratoconus” (Isik et al)
This case study caught my eye due to the use of scleral lenses in an 11-year-old and particularly after corneal crosslinking and vernal keratoconjunctivitis, as we have quite a few parents of young KCN patients in the Facebook group. The authors highlighted the need for frequent monitoring of lens fit.
“Half Patches Require Full Lenses: Scleral fitting for a post-op bilateral patch graft patient” (Killen et al)
One of my personal key take-homes from this conference has been scleral lens concerns peculiar to corneal transplant patients in a variety of circumstances. We have so many of those in the Facebook group (with old, new, single or multiple, partial or full thickness corneal transplants) and I speak with them frequently as well at the shop. I have greatly appreciated the opportunity to learn more about scleral lens risks specific to these users. This poster was about a less common situation - nasal patch grafts - and a successful scleral lens fitting but noting the need for special design considerations and heightened risks that have to be monitored regularly.
“Extended Wear Scleral Lens - A Last Resort” (Zabrowski)
One of the reasons I wanted to highlight this one is, first, to just point out that there are sometimes creative options in these extreme cases where nothing else ever seems to work… I know we have some of you in the group. But another reason is because I have been feeling more and more aware of the extent of self-diagnosis and treatment that goes on and I wonder sometimes, when we get a rare post about wearing sclerals overnight, whether there might be "copycatting" going on. So I wanted to take the opportunity to highlight how the medical community feels about this: they consider it very high risk behavior, and something that shouldn’t be done without very close physician monitoring.
“Impact on gas-permeable contact lens parameters after storage in a non-neutralized hydrogen peroxide case during 1 to 30 days” (Michaud et al)
These are the kinds of practical topics a lot of us patients want. There have been questions regularly in the group about how to store lenses when not in use. (Not to be confused with the question of what solution to store, or rather to disinfect, lenses in overnight!) One of my big safety concerns is that not everyone realizes that if you put lenses in a ClearCare case, with solution, and leave them there, it’s no different than leaving them in a jar of preservative-free saline, which is not considered a safe long term storage option.
So anyway, this poster:
- Pointed out the failure of the solution manufacturer to provide a case in which our lenses actually fit! Would someone kindly give Alcon the memo?
- Suggested, after verifying that it does not alter the lenses, storing sclerals in a conventional contact lens case in NON neutralized hydrogen peroxide.
“Scleral lens fitting complications in a non-compliant patient with ocular surface disease” (Jessica Tu OD)
This is an acanthamoeba keratitis case I mentioned on Facebook the other day. The patient is a Sjogrens patients who had to have full thickness cornea transplants in both eyes. She had been using well water regularly on her hybrid lenses and this is what her AK infection was attributed to. (By the way, this is not a criticism of well water. All water - tap, well, purified, distilled - carries acanthamoeba risk.) But there are really a number of other features in the paper that resonated with me for our FB group:
- Complicated and difficult: Sjogrens, dry eye obviously, “mucous fishing syndrome”… and then transplants? Yikes.
- She had been to lots of doctors with, apparently, some conflicting diagnoses (many of us have been there!)
- She had to travel a long distance for scleral lens fittings, which makes follow-up difficult (again, many have this dilemma)
- The cost of taking proper case of scleral lenses is significant, but yet compares favorably to the cost of dealing with complications from failing to take proper care of them!
“Scleral lenses: Two birds, one stone” (Abreau et al)
Well, I never had anything as nasty as the corneal flap melt patient in this poster, but otherwise saw plenty of myself and friends in their language:
“Unfortunately, some people only experience negative results from a LASIK procedure…” Check… I believe my central islands, masses of coma and spherical aberration, dry eye and pain, qualify as negative results.
“RGP lenses, especially scleral lenses, are a great option for patients who exhibit dry eyes, irregular astigmatism, and are otherwise unhappy in their glasses or soft contact lenses.” Check… at 20/80 BSCVA and uncomfortable, yes - I would not be particularly happy in glasses.
“She also suffers from ocular surface disease that precluded comfortable corneal GP wear.” Check. I tried everything from corneal lenses to piggybacking to corneal-scleral to mini scleral before moving into 18.5mm scleral lenses in 2006
“Scleral lenses offered her refractive correction beyond the limitation of glasses and soother her dry eye by providing all day moisture to the surface of her eyes.” Check. Dual purpose lenses.
I wish everyone considering LASIK had the opportunity to read some of the language in this poster, such as “Dry eye is the most common consequence of LASIK, although it is usually a short-term problem. LASIK adds to the patient’s signs and symptoms of dry eye as the procedure damages corneal nerves and goblet cells during the creation of the flap. Inflammation during the healing process can also worsen pre-existing dry eye conditions.” On the other hand, it would probably still get blown off just the way normal consent forms do, especially when the surgeon re-assures the patient that s/he has never had a patient with that kind of outcome. (Ahem. Attempting to dismount my soapbox now....)
“Challenges of fitting scleral lenses on a patient with blepharophimosis” (Amanda Golchin OD)
The case presented here was a patient with extreme eyelid abnormalities, and the reason I wanted to point it out is just that I’m appreciating seeing doctors working to find the right lens and the right approach to make it possible for people to wear scleral lenses when there are compelling reasons to do so, despite major difficulties with getting the lenses onto the eyes. I think the take-home, once again, is that so many scleral lens needs are provider-specific. I always urge everyone who is considering scleral lenses for a special need to ask the provider about specific similar cases that they’ve treated. The process of being fitted for sclerals can be quite involved and very stressful for us patients, and being the case someone learns on is not necessarily in our best interest if it can be avoided. We need to seek out the providers that truly are best equipped to serve our individual needs through prior experience.
“Warp! There it is: Scleral lenses improve corneal warpage secondary to tight lids” (Myers et al)
This one really surprised me… I guess I’m so used to thinking of tight lids only in the sense of how hard they make it for people to get scleral lenses in. But this was the opposite sort of case, where the scleral lenses were actually used to protect the eyes from the tight lids themselves… apparently the lids were associated with causing irregularities in the patient’s vision. Fascinating.