The literal meaning of 'wicked' may be 'playfully mischievous' or even 'evil', but in colloquial or everyday language, it can also have a positive connotation, as in: 'that was wicked good, man!' Well, our ‘good old’ corneal GP lens - in modern language more and more referred to as 'rigid corneal lens' or RCL, as adapted from the BCLA CLEAR consensus papers - seems to be part of a modern revival and could use some of that modern language. In reviewing this year’s Global Specialty Lens Symposium poster submissions (156 in total!), not just one or two - but several – poster’s case reports discussed trying a scleral lens for a patient but then reverting back during the fitting process to other lens modalities, including good old corneal rigid lenses, to best serve the patient. Bottom line: corneal lenses can be a comparable option and solve some of the scleral lens issues we see (like fogging or handling). For many in Europe, that is actually the contact lens world upside down, but in North America it is not uncommon to think that way. In short: let’s not see corneal rigid lenses as bad or old-fashioned but as something potentially positive for patients. Or, as I overheard a young patient recently fitted into corneal rigid lenses say: 'These lenses are wicked, Bro'.

Each October issue of Contact Lens Spectrum features a specialty lens (corneal lenses, sclerals & custom soft lenses) special edition. A few handpicked items from that edition are highlighed here.

Kate Gifford in her contribution writes about a hot topic at the cutting edge of ortho-k research and practice: altering lens design to influence myopia control efficacy. Ortho-k has the greatest volume of evidence for slowing axial eye growth in myopic children, Kate writes; data combined from several studies show a consistent effect of 0.27mm less growth over two years. Ortho-k also holds the special distinction of being the only intervention with evidence for slowing anisomyopic eye growth—in the presence of astigmatism up to 3.50D and for partial treatment of high myopes from –6D to –8D. Can there be more to expect from this workhorse of myopia management, she asks? All ortho-k lenses are “customized” to a patient’s topography and refraction, but reducing the back optic zone diameter (BOZD) could be a key factor to potentially further crank up the efficacy. A randomized controlled trial by Guo et al (2022) compared 5mm to 6mm BOZD lenses and found a significantly better myopia control effect for the 5mm lens in the first six months. The second and fourth six-month periods showed a similar progression trajectory in both groups, while the third six-month period (from 12 to 18 months) showed a slightly better effect again in the 5mm group. Over two years, the 5mm group’s eyes grew 0.15±0.21mm compared to 0.35±0.23mm in the 6mm group. Before fitting all young patients into 5mm BOZD lenses, be aware that reduced contrast vision has been noted in some wearers, the article states. There is much to learn it seems, but there surely seems to be potential. For full coverage, see link below (open access).

Langis Michaud contributed an interesting case, with food for thought. A a 33-year-old computer analyst presented with a chief complaint of fluctuating and unsatisfactory vision while wearing toric soft lenses. After deciding to fit this patient in a rigid corneal lens, the author, as a supervisor in the clinic, was challenged by a student: why didn’t he use a scleral lens? Or another soft lens for that matter? The choice of the rigid corneal lens was based on a detailed analysis. First, the patient was hyperopic and astigmatic, which limited the options for soft lenses. The patient’s cornea was flatter than average, his corneal diameter was larger (12.1mm), and he had 6mm pupils (versus a 4.5mm optic zone)—all of which contributed to his visual discomfort with soft toric lenses. The sagittal height of his eyes was quite impossible to match with commercial soft toric lenses. In addition, his corneal astigmatism was higher than his refractive astigmatism (–3.50D versus –2.25D). This case represents the ideal scenario for prescribing a rigid back-toric lens. This option is easy to fit (empirically) and provides stable visual acuity in 99% of cases. Yes, a scleral lens was an option too. The conclusion of his answer to the student was simply that not everything is purely black or white with contact lenses. We are very fortunate to have multiple shades of gray in our hands to meet our patients’ needs. The only limitation that exists is our own hesitation to make full use of all of the tools we have on hand. We shouldn’t choose just one; we have to learn to use them all for the benefit of our patients. See full case report via link below (open access).

A webinar with this title was presented by Jennifer Harthan and Pam Satjawatcharaphong on Tuesday, November 15th, 2022 and is available now on the GPLI archive webinar website. Some of the highlights include that while there is a well-established relationship between poor contact lens and case hygiene and adverse ocular events, there is a disconnect in how this is perceived (in both patients and practitioners). Regarding the patients, in a survey of 162 contact lens wearers, 86% believed they were compliant but only 34% actually were compliant - and 80% of lens wearers reported being aware of risk factors but ignoring them. Contact lens wearers are often not aware of the specific contact lens care system they are prescribed or are using, and they are often not aware of the steps for cleaning and disinfection of lenses and cases or of the replacement schedule. For the practitioner, disinfection protocols for corneal and scleral lenses are discussed: rub all lenses after use with a daily surfactant cleaner, followed by a minimum 3-hour soak in non-neutralized ophthalmic grade 3% hydrogen peroxide, rinse thoroughly with sterile saline or multipurpose solution and store dry, reclean and rinse before application. For full webinar: see link below (open access).