Advanced Scleral Lens Troubleshooting

Scleral lenses can be life-changing for patients with corneal and ocular surface disease.  However, troubleshooting the problems that arise can be difficult for even the most experienced fitter.   This course offers more advanced problem-solving techniques for practitioners who would like to enhance their scleral lens skills. 

Learning objectives

1. To discuss design changes to help achieve improved scleral lens fits
2. To demonstrate how to manage advanced corneal pathology with scleral lenses
3. To provide strategies to improve solution issues including toxicity and hypersensitivity reactions
4. To discuss the causes and problem-solving strategies of poor wetting and mid-day fogging
5. To discuss how scleral topography can help fitting techniques
6. To discuss how impression-based designs can help problem solve difficult fits
7. To demonstrate the benefits of front surface aspheric optics to improve vision
8. To demonstrate the advantages of Higher Order Aberration correction (HOA technology)

1. Lens Suction
   1. Cause of suction
   2. Symptoms involved
   3. Lens on vs lens off
   4. Problem solving to reduce suction
2. What to do when everything is fine on SLE and OCT and pt is still uncomfortable
   1. Edge is slightly loose
   2. Edge is slightly tight
   3. Smaller or larger
      1. Indications for large scleral lenses
      2. Indications for small scleral lenses

1. Vaults
   1. When do we use them
   2. Bi-elevation
      1. What are they
      2. When do we use them
   3. Adequate limbal clearance
      1. Complications if too much or too little clearance
      2. Can we achieve optimal clearance
   4. Case reports on improvements of fit designs to reduce complications
2. How to manage toxic keratitis
   1. What solutions can we use to clean and fill the lens
      1. Change lens material
      2. Change lens manufacturer
3. Mid-day fogging causes and management techniques
   1. Non-polar lipids
      1. Inflammatory cells
      2. Can we identify the cause of fogging
      3. How to manage mid-day fogging
      4. Dry eye treatments
4. Management of anterior surface fogging
   1. Improve lipid layer
      1. Material changes
      2. Lower wetting angle
      3. Lens coatings
      4. Corneal clearance
      5. Wind-shield wiper treatment of lens
5. Treatment of hypersensitivity reactions
   1. Lens, lens coatings, solutions or external stimuli
      1. How treat hypersensitivity responses
6. Corneal edema
   1. Corneal transplant/Post-herpetic patient/Penetrating injury
   2. Problem with PK’s post cataract surgery
   3. Problem with aphakes
   4. Fitting strategies
      1. Reduce clearance centrally and midperipherally
      2. Reduce thickness
      3. Flatten fit
      4. Increase Dk
      5. Fenestrations
      6. Reduce wear time
      7. Adding steroids and/or hypertonic
      8. Endothelial transplant
7. Scleral topography
   1. Indications -decide on a starting lens
   2. Benefits of scleral topography over traditional scleral lens fitting
   3. When is a free-form necessary
   4. Does it save chair-time
8. Impression mold technology
   1. Indications
   2. How to use it
   3. Benefits of impression mold technology over traditional lenses
   4. Challenges of impression-based molding
   5. Case report demonstrating how impression technology improved the fit over traditional scleral lenses
9. HOA technology vs aspheric optics
   1. When to use aspheric optics vs. HOA technology
   2. What is HOA technology and how do we apply it to contact lenses
   3. What type of patient is HOA correction indicated for
   4. Case report on how HOA technology benefited a patient