These four areas were addressed:



Advancements in scleral lens materials and clinical implications

• Importance of optimizing oxygen due to the sealed fit and potential hypoxia
• Results of studies of predicting what Dk values, center thickness (keep to a minimum), and tear reservoir would optimize oxygen transmission. A minimal Dk of 150 was recommended and there are several materials available today that meet this criterion and perform quite well. Minimizing the tear fluid reservoir can be quite effective in minimizing hypoxia.

Advances in surface treatments of scleral lenses and their clinical implications

• This began with plasma treatment but has progressed to Hydra-PEG. He recommends having a treatment/coating for all scleral lenses. There is a Boost treatment available on a monthly basis to maintain the surface coating and wettability. He presented a number of cases and a very pertinent one was a graft-versus-host-disease patient who was not successful until Hydra-PEG was used. He did mention that, on occasion, a patient would prefer a non-Hydra-PEG lens as they feel the coating interferes with the optics and impacts vision. He recommends if they are a current scleral lens wearer and doing well to not add the coating. However, for all new scleral lens patients, notably those with ocular surface disease, to utilize Hydra-PEG.

Advancements in scleral measurement and software for fitting scleral lenses. He discussed the benefits and applications with scleral lenses of using:

• Topography
• Optical Coherence Tomography
• Scheimpflug Tomography
• Corneo-Scleral Topography: this is particularly beneficial for both obtaining good scleral lens shape information and designing lenses based on this information.

The utilization of using the most advanced technology for scleral assessment has the benefits of empirical fitting, better alignment of lens-to-sclera - optimizing first-fit success - and reducing the number of lenses typically needed as compared to fitting diagnostically. The decision to utilize toric lens optics can be made quite easy and the design can accommodate pterygia and other scleral surface challenges.

Advances in optical correction and clinical implications.

• Higher order aberrations. Important to correct in keratoconus due to back surface irregularity and much of the high order aberrations are positive coma. Need to use a lens that is rotationally stable and then measure the lens with an aberrometer and this information is analyzed and used in the redesign of the lens to determine the front surface correction to correct for the residual high order aberrations. He presented an example in which the vision improved from 20/50 to 20/25 with a corrected lens versus a standard scleral design.
• Multifocal Designs. They are simultaneous designs due to lack of translation with the blink. That said, with the ability to use the same wavefront technology with multifocal lenses as spherical designs, in combination with the ability to decenter the optics, can result in good visual performance.
• Prism – up to 4 - 5D – can be added in each quadrant.

UPCOMING WEBINAR

"The Latest in Contact Lens Care for Scleral Lenses"

Susan Gromacki, OD, MS, FAAO, FSLS

Tuesday, March 21st • 8 PM Central

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SPOTLIGHT ON BONUS WEBINAR

"Specialty Contact Lens Coding and Billing Update"

Clarke Newman, OD, FAAO, FBCLA, FSLS, FNAP

Tuesday, April 4th • 8 PM Central

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As a result of changes in third party groups, GPLI coding and billing module coordinator, Dr. Clarke Newman, volunteered to present a bonus webinar, open to everyone, on the topic of Specialty Contact Lens Coding and Billing Update.” For anyone desiring to feel confident in coding and billing appropriately for their specialty lens patients in 2023, as well as have their questions answered, this is a “Must See” presentation.