The use of scleral lenses in the practice of a refractive surgeon

Abstract

Introduction: Skleral lenses are rigid gaspermeable. The peculiarity of these lenses is that they rest on the sclera and do not touch the cornea and limbus. Before donning, the lens is filled with sterile NaCl solution or sterile hyaluronic acid solution and this post-lens aqueous layer is located between the lens and the cornea during lens wear. Thus, the lens doesn’t touch the cornea and doesn’t cause corneal syndrome. It’s always very comfortable for the patient. Scleral lenses can be fitted for any refractive situation on an intact cornea and after any corneal surgery. Purpose: To analyze the effectiveness of scleral lenses from the SkyOptix laboratory in several clinical cases of patients with refractive errors after keratorefractive surgery. Materials: Scleral lenses from SkyOptix laboratory were fitted to 4 patients with a history of refractive corneal surgery. Patient 1: woman, 38 years old. High grade hyperopia, astigmatism OU. Visometry: VIS OD 0.15 sph (+) 8.0 cyl (-) 3.0 ax 155 = 0.9 VIS OS 0.15 sph (+) 7.75 cyl (-) 2.5 ax 35 = 1,0 Pachymetry data: OD 624, OS 625 μm. Keratometry data: OD flat K 35.15 steep K 39.18; OS flat K 36.28 steep K 39.04 In scleral lens VIS OD = 0.9, VIS OS = 1.0 Patient 2: female, 19 years old. High myopia, condition after PRK OU. Subepithelial fibrosis developed on the left eye. Visometry: VIS OD = 1.0, VIS OS 0.1 sph (-) 5.0 cyl (-) 3.0 ax 170 = 0.4. Pachymetry OS = 408 μm. In scleral lens, Vis OS = 0.7. A higher visual acuity couldn’t be achieved due to a violation of the transparency of the optical media. Patient 3: female, 20 years old. Moderate myopia, condition after LASIK OU. Thise patient had one of the most common conditions after excimer laser correction - keratoectasia. Formed a year after surgery. Visometry: VIS OD 0.15 doesn’t correct, VIS OS 0.15 sph (-) 20.0 cyl (-) 2.5 ax 170 = 0.4 Pachymetry data: OD 300, OS 343 μm. Keratometry data: OD flat K 62.68 steep K 76.16; OS flat K 59.26 steep K 70.26 In scleral lens VIS OD = 0.9 VIS OS = 1.0 Patient 4: female, 62 years old. Radial keratotomy in 1986, then FEC + IOL in 2016. Light scattering complaints. Visometry: VIS = 0.8 When carrying out aberrometry, high aberrations of the lowest order were revealed, which causes blurring of the image, especially in the dark. In scleral lens, VIS = 1.5. The lens also showed a significant reduction in spherical oberrations. Thanks to lens design with compensation for spherical aberrations of the refractory water layer. Result and conclusion: in all observed patients with refractive errors after keratorefractive surgeries, it was possible to achieve high visual acuity using the scleral lenses of the SkyOptix laboratory, which were optimally fitted. For patients 2 and 4, binocular vision was restored. All patients successfully adapted to scleral lenses. Thanks to a special spherical aberration compensation protocol, it is possible not only to improve visual acuity, but also to reduce light scattering and improve image clarity.