Contemporary Scleral Lenses: Theory and Application

Book Series: Ophthalmology: Current and Future Developments

Volume 4

by

Melissa Barnett, Lynette K. Johns

DOI: 10.2174/97816810856611170401
eISBN: 978-1-68108-566-1, 2017
ISBN: 978-1-68108-567-8
ISSN: 2468-7162 (Print)
ISSN: 2468-7170 (Online)



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Table of Contents

Foreword

- Pp. i
Jan P. G. Bergmanson
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Preface

- Pp. ii-iii (2)
Melissa Barnett and Lynette K. Johns
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List of Contributors

- Pp. iv-v (2)
Melissa Barnett and Lynette K. Johns
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Prologue

- Pp. vi-xiv (9)
Melissa Barnett and Lynette K. Johns
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History of Scleral Lenses

- Pp. 1-47 (47)
Timothy J. Bowden and Melissa Barnett

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Scleral Lens Anatomy

- Pp. 48-67 (20)
Lynette K. Johns and Melissa Barnett

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Understanding Anterior Ocular Surface Shape

- Pp. 68-87 (20)
Eef van der Worp, Gregory DeNaeyer and Patrick Caroline

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Scleral Lens Optics

- Pp. 88-96 (9)
Muriel Schornack

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Medical Indications for Scleral Lens Use

- Pp. 97-129 (33)
Muriel Schornack

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Scleral Lenses for the Regular / Normal / Non- Diseased Cornea

- Pp. 130-156 (27)
Langis Michaud

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Instrumentation

- Pp. 157-182 (26)
Jeffrey Sonsino, S. Barry Eiden and Randy Kojima

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Initial Lens Selection

- Pp. 183-200 (18)
Jason Jedlicka

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Scleral Lens Evaluation

- Pp. 201-241 (41)
Lynette K. Johns, Jennifer Anne McMahon and Melissa Barnett

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Documentation

- Pp. 242-283 (42)
Bruce Baldwin

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Examination Flow for Scleral Lens Fitting

- Pp. 284-302 (19)
Brooke Messer and Stephanie Woo

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Scleral Lens Complications and Problem Solving

- Pp. 303-345 (43)
Karen G. Carrasquillo, Michael J. Lipson, Damon J. Ezekiel, Lynette K. Johns and Melissa Barnett

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Scleral Lens Handling

- Pp. 346-370 (25)
Melissa Barnett and Mindy Toabe

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Scleral Lens Challenges

- Pp. 371-434 (64)
Melissa Barnett, Karen G. Carrasquillo, Gregory DeNaeyer, S. Barry Eiden, Karolien Elving-Kokke, Jason Jedlicka, Carina Koppen, Michael J. Lipson, Jason Marsack, Jennifer Anne McMahon, Henny M. Otten, Young Kee Park, Perry Rosenthal, Esther-Simone Visser, Lynette K. Johns, Maria K. Walker and Geunyoung Yoon

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Scleral Lens Patient Recruitment

- Pp. 435-450 (16)
Damon J. Ezekiel

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Collaborative Care of the Scleral Lens Patient: Working with Referring Doctors

- Pp. 451-462 (12)
Jennifer Y. Li and Deborah S. Jacobs

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Subject Index

- Pp. 463-477 (15)
Melissa Barnett and Lynette K. Johns
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Foreword

The re-emergence of the scleral lens – in its modern design – is a recent technological and medical advancement in the care of patients with distorted and diseased corneas. These devices are capable of providing a phenomenal improvement of vision with remarkable comfort. The improvement in quality of life these devices offer cannot be minimized.

When healthcare makes significant advances, the need for education on such developments is vital, so that more healthcare practitioners become trained in employing an innovation and, as a result, more people benefit. It is in this context that Contemporary Scleral Lenses: Theory and Application is a most welcome and valuable addition to the literature. This text is edited and written by two eminent clinicians and scholars in the field of scleral lenses, Drs. Melissa Barnett and Lynette Johns. They are aided by some of the most distinguished practitioners in this modality. These experts have between themselves a great number of years of experience with scleral lens management of complex corneas, which they generously share with the reader.

A review of the content of this text reveals that this volume is remarkably comprehensive. It is carefully authored and referenced and starts with an exceptionally interesting historical chapter. The reader will be taken through lens design and optics but also the topography of the ocular surface. A complete chapter is dedicated to relevant instrumentation used in a scleral lens practice. Several chapters are devoted to the assessment of ocular health, lens fit and complications. All chapters are richly illustrated by carefully selected images. This makes Contemporary Scleral Lenses: Theory and Application a most useful educational tool. Optimal scleral lens fitting is carefully described along with potential complications. Integrated throughout the text are thoughtful and useful problem solving recommendations.

As we become more accustomed to scleral lenses in anterior segment management, we realize that scleral lenses do not need to be limited to the abnormal eye. They indeed may be utilized for the normal eye. An entire chapter addresses this indication.

The comprehensive design of this book describes everything from the beginning to the end and from the simplest to the most complex. Therefore, it makes an appreciated information source for the student or the novice. However, this text book with its wealth of information, the number of clinical pearls and the quality of illustrations offer even the experienced and most seasoned scleral lens practitioners valuable information and opportunities to learn.

Drs. Barnett and Johns are to be congratulated on the completion of their exceptionally useful and impressive text, Contemporary Scleral Lenses: Theory and Application, which is arriving at a time when we have a relative lack of educational material. This text book will most certainly find a place in my personal library and computer.

Jan P. G. Bergmanson
Brien A. Holden Professor of Optometry,
Texas Eye Research and Technology Center,
University of Houston College of Optometry,
4901 Calhoun Rd, Houston, Texas 77204,
USA

Preface

Contemporary Scleral Lenses: Theory and Application covers a vast array of scleral lens topics to inspire novice practitioners and provide valuable pearls to experienced practitioners. From the fascinating history of scleral lenses and how they evolved to the modern scleral lenses used in clinical practice today, this book highlights major advances in scleral lenses. The description of basic lens structure, optics and customizable features combined with the characterization of ocular surface shape intricacies allow the reader to conceptualize and appreciate the unique fitting relationship of a scleral lens. Scleral lens fitting had long been described as an art, however cutting edge information on technology in the scleral lens practice emphasizes the evolving scientific and objective approach to scleral lens fitting.

Examination flow, evaluation and documentation can help even the expert scleral lens practitioner. For those interested in setting up a scleral lens practice, an entire chapter is dedicated to recruiting and marketing the scleral lens practice. For the student and novice practitioner, a chapter is solely dedicated to scleral lens care and handling. There are a variety of complex medical and ocular indications for scleral lenses that are described in detail. These patients require many different specialists for their ocular and systemic care, and the unique perspective from esteemed corneal specialists regarding collaborative care of the scleral lens patient is included in this book. Utilization of scleral lenses for patients with regular corneas is gaining popularity and is also covered.

The purpose of this book is to aid the student, new and proficient practitioners to fit, evaluate, identify and manage scleral lens complications. We hope that this text will help practitioners to grow their scleral lens practice, collaborate with other practitioners and, most importantly, help patients to improve their vision, rehabilitate their ocular surface and improve their quality of life.

The future of scleral lenses requires exploring the intricacies of this modality. There is so much research that needs to be done with scleral lenses. Multiple authors provide their opinions and strategies when facing unique challenges of scleral lenses that are not described in publications elsewhere. We hope that this text will inspire further scleral lens research and publications.

We are honored to have this opportunity to publish this text. We thank you for reading and learning about this modality, which in turn helps patients improve their lives with scleral lenses. We hope that Contemporary Scleral Lenses: Theory and Application is a welcome reference that assists you in implementing scleral lenses into your practice.

ACKNOWLEDGEMENTS

It was an incredibly daunting thought to even imagine writing a book on contemporary scleral lenses. Many thanks and sincere gratitude to Matthew Kennedy and his wife Rebecca Kennedy, OD who encouraged us to undertake this project.

The unremitting encouragement and sacrifice of our families made it possible to devote the endless hours and years to complete this text. We would especially like to thank Todd, Alex and Drew Erickson and Khaled Imad for their unwavering love and support as we embarked on this formidable, yet incredible journey.

It is not possible to write this text without a collaborative effort. We are so appreciative of the support of our global scleral lens community to come together, cheer us on and contribute to this text. This work would not have been possible without the assistance of our authors. Many thanks to our authors: Bruce Baldwin, Jan Bergmanson, Tim Bowden, Patrick Caroline, Karen Carrasquillo, Gregory DeNaeyer, Barry Eiden, Karolien Elving-Kokke, Damon Ezekiel, Don Ezekiel, Deborah Jacobs, Jason Jedlicka, Randy Kojima, Carina Koppen, Jennifer Li, Michael J. Lipson, Jason Marsack, Jennifer McMahon, Brooke Messer, Langis Michaud, Henny Otten, Young Kee Park, Ken Pullum, Perry Rosenthal, Muriel Schornack, Jeffrey Sonsino, Mindy Toabe, Eef van der Worp, Esther-Simone Visser, Reints Visser, Maria K. Walker, Stephanie Woo and Geunyoung Yoon.

Melissa Barnett
University of California,
Davis, Sacramento, California, USA
E-mails: drbarnett@ucdavis.edu

&

Lynette K. Johns
The New England College of Optometry,
Boston, Massachusetts, USA
E-mails: johnsl@neco.edu

List of Contributors

Editor(s):
Melissa Barnett
University of California
Davis, Sacramento, California
USA


Lynette K. Johns
The New England College of Optometry
Boston, Massachusetts
USA




Contributor(s):
Barry Eiden
North Suburban Vision Consultants, Ltd
Keratoconus Specialists of Illinois
Deerfield, IL
USA


Brooke Messer
Cornea and Contact Lens Institute of Minnesota
Edina, MN, USA


Bruce Baldwin
Department of Ophthalmology
University of North Carolina
Chapel Hill, NC
USA


Carina Koppen
Faculty of Medicine and Health Sciences
University of Antwerp
Antwerp
Belgium
/
Department of Ophthalmology
Antwerp University Hospital
Edegem (Antwerp)
Belgium


Damon J. Ezekiel
Ezekiel Eyes
Nedlands, WA
Australia


Deborah S. Jacobs
BostonSight
Needham, MA USA, Massachusetts Eye & Ear
Boston, MA, USA


Eef van der Worp
University of Maastricht
Masstricht
Netherlands
/
École d’optomĂ©trie
de l’UniversitĂ© de MontrĂ©al
Montréal, QC
Canada
/
Pacific University College of Optometry
Forest Grove, OR
USA


Esther-Simone Visser
Visser Contactlenzenpraktijk B.V.
EJ Nijmegen
Netherlands


Geunyoung Yoon
University of Rochester Medical Center, Rochester, NY, USA



Gregory DeNaeyer
Arena Eye Surgeons
Columbus, OH
USA


Henny M. Otten
Visser Contactlenzenpraktijk B.V.
EJ Nijmegen
Netherlands


Jason Marsack
University of Houston
Houston, TX
USA


Jason Jedlicka
Indiana University
Bloomington, IN
USA


Jeffrey Sonsino
Optique, PLLC
Nashville, TN
USA


Jennifer Anne McMahon
Great Western Hospitals NHS FT
Swindon
UK


Jennifer Y. Li
University of California
Davis, Sacramento, CA
USA


Karen G. Carrasquillo
BostonSight
Needham, MA
USA


Karolien Elving-Kokke
Visser Contactlenzenpraktijk B.V.
EJ Nijmegen
Netherlands


Langis Michaud
École d’optomĂ©trie
de l’UniversitĂ© de MontrĂ©al
Montréal, QC
Canada


Lynette K. Johns
The New England College of Optometry
Boston, MA
USA


Maria K. Walker
College of Optometry
University of Houston
Houston, TX
USA


Melissa Barnett
University of California, Davis
Sacramento, CA
USA


Michael Lipson
Department of Ophthalmology and Visual Science
University, Northville, MI
USA


Mindy Toabe
MetroHealth Medical Center
Cleveland, OH
USA


Muriel Schornack
Department of Ophthalmology
Mayo Clinic
Rochester, MN
USA


Patrick Caroline
Pacific University College of Optometry
Forest Grove, OR
USA


Perry Rosenthal
Harvard Medical School
Boston, MA
USA
/
Boston Eye Pain Foundation
Boston, MA
USA


Randy Kojima
Pacific University College of Optometry
Forest Grove, OR
USA


Stephanie Woo
Havasu Eye Center, Lake Havasu, AZ, USA



Tim Bowden
Bowden & Lowe
Kent
UK


Young Kee Park
The Korean Ophthalmological Society, Malli-dong 1-ga
Seoul
South Korea




Reviews

Review 1

After reading through this large volume, I find that Contemporary Scleral Lenses (abbreviated CSL below) is a very comprehensive view of modern scleral contact lens practice, heavily weighted towards the practical clinical care of patients - but with much reference to both the science underpinning modern contact lens practice in general as well as scleral lenses, and the history of this particular sub-branch of practice.

In sum, this text, organized into 16 chapters, with reasonable references, spans the area thoroughly.

I believe that both the novice wishing to begin scleral lens practice, and the seasoned practitioner wishing to gain advanced knowledge and perspective, will appreciate this book.

I do, however, suggest that even the novice reader should have some previous background in contact lens science and care, both of rigid and soft lenses, with some familiarity with the terms such as base curve and toricity. Perhaps there should be a suggestion of some of the more general CL texts which are available and which should be perused prior to undertaking CSL.

I note clean clear writing throughout, a compliment to the editors I am sure, but also, unfortunately, an modest amount of un-necessary overlap here and there; this latter is often a problem with many chapters contributed by various authors in the same area of knowledge. In sum, I enjoyed the reading of this text and gained more than a few insights and clinical pearls. It is up to date, comprehensive, and clear, and a worthwhile addition to the library of any clinician or scientist working or teaching in the area of scleral contact lenses.

Barry A. Weissman, OD, PhD, FAAO (Dip CCLRS section)
Professor of Optometry, Southern California College of Optometry at Marshall B Ketchum University, Fullerton CA USA
Emeritus Professor of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles CA, USA



Review 2

Book Review by Cristian Mertz, (optometrist, professional service manager Microlens) VISUS, Netherlands, September, 2018.
https://visus.optometrie.nl/visus-4-2018/boekbespreking-contemporary-scleral-lens/


Review 3

Contemporary Scleral Lenses: Theory and Application is a very comprehensive clinical ‘how to’ resource for everyone interested in fitting scleral lenses. The authors are prolific writers, lecturers, and clinicians. Dr. Melissa Barnett, Principal Optometrist at the University of California, Davis Eye Center, is an exceptional scleral lens fitter with every conceivable lens design as well as a noted author. Dr. Lynette Johns, Adjunct Assistant Professor at the New England College of Optometry and formerly associated with the Boston Foundation for Sight, has a wealth of experience with large scleral designs and may quite be the most in-demand lecturer on scleral lenses. Both authors are outstanding instructors as it pertains to ‘hands-on’ scleral workshops and have trained a significant number of eye care practitioners (ECP).

This 477-page text includes contributions from over 30 of the foremost experts in scleral lens fitting in the world. The text includes over 300 figures, helping ECPs to design, evaluate, and problem-solve scleral lens designs. It is available in several formats (i.e., personal ebook, printed copy, or combination pdf and printed copy), with the ebook being the most economical and likely most popular.

This text will answer all of your scleral lens questions including: 1) What patients should I fit into scleral lenses? 2) What specific lens design should I select? 3) How much clearance is optimum? 4) When should I use toric haptics? 5) How can I optimally use topography and optical coherence tomography (OCT) with scleral lens patients? 6) How can I manage problems such as a) the tight-fitting lens, and b) mid-day fogging? and 7) Where can I go for help?

Among the chapters in the text are those that pertain to scleral terminology, lens design and scleral lens anatomy, medical applications (an outstanding chapter from Dr. Muriel Schornack), sclerals for healthy eyes (i.e., presbyopia and astigmatism), patient recruitment, instrumentation (i.e., topography, OCT, slit lamp, etc.), lens selection, lens evaluation, how to properly document findings, lens care and patient education, and management of complications. My sense is that the two most popular chapters will be the one pertaining to “Scleral Lens Complications and Problem-Solving” and the one entitled: “Scleral Lens Challenges”. The problem-solving chapter includes the diagnosis and management of such conditions as edema, neovascularization, limbal bearing, staining, hyperemia, conjunctival hypertrophy, conjunctival prolapse, mid-day fogging, tear reservoir debris, poor surface wettability, reduced vision, poor comfort, and handling difficulties. The challenges chapter includes contributions from 17 experts on a wide range of problems and challenging patients who benefit from scleral lenses. This includes several of the aforementioned problems as well as conjunctival blebs, glaucoma draining device, symblepharon, impression molded sclerals, infiltrates, graft rejection, pediatric applications, neurotrophic corneas, and handling challenges.

I also loved the least applied chapter in the text pertaining to the history of scleral lenses as written by ‘the expert’ on contact lens history, the late Tim Bowden. It was fascinating to learn about the origins of scleral lenses which for centuries paralleled the origins of contact lens history in general.

Edward S. Bennett OD, MSEd, FAAO, FSLS
College of Optometry
University of Missouri-St. Louis
One University Boulevard
St. Louis, MO 63121



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