Gas-Permeable Scleral Contact Lenses

Extract of letter from an Consultant Opthalmic Surgeon regarding a patient:

'Astonishing result. I am very impressed with the improvement. He is a very happy young man as well.'

'Thank you very much for persuading me to get a pair of Scleral Contact Lenses. Although they are large I find them extremely comfortable and my visual stability had greatly improved.'

Extracts of email from D/MG:

'Never ever seen so clearly - i can now enjoy watching football even if the other team win !'

'I can swim with my eyes open'

'My lens never fall out any more'

To whom it may concern.

I was fitted with a new scleral lens by my Optician Mr Sam Silver appros. 2 months ago. I was first diagnosed with Keratoconus 7 years ago and this new lens has given me great benefits. The initial period of getting used to the much larger lens is very manageable and it took a period of 2 to 3 weeks for me to become fully comfortable with insertion and removal.

I have outlined some of my thoughts on these lenses below and would not hesitate to recommend them to anybody in my situation.

Benefit of scleral lens:

Greater Stability of Vision

• Better all round vision due to less movement of the lens.
  
• Less strain on the eye as vision does not shift.
  
• More inclined to wear for a longer period as vision is better.

Greater Comfort of Wear

• Compared to rigid gas permeable lens much lens movement.
  
• No irritation of lens on the eyelid.
  
• As cornea is untouched, no scratchy or gritty feeling from eye.
  
• The eye is much more comfortable with no problems from either excessive tears or dry eyes which gives the wearer better vision for longer periods.

Practice Benefits

• Durable and easier to handle than normal RGP lens for cleaning and maintenance.
  
• No chance of lens being lost accidentally.
  
• Much more practical for sports and outdoor activities
  
• Much better for night driving - large decrease in the halo effect.

MR SHERAZ M DAYA
MD FACP FACS FRCS(ED)
Consultant Ophthalmic Surgeon
Centre for Sight

20 October 2003

Mr Sam Silver
Contact Lens Optician

Dear Sam,

RE: JH

Thank you for your kind referral whom I saw in consultation today. As you indicate this gentleman who has a history of atopy and allergic Rhinitis does indeed have keratoconus in both eyes, worse in his right.
At examination today with his contact lenses in place his visual acuity were 6/6 right eye and 6/9.5 -2 left eye. The scleral fit in his left eye was excellent with good limbal clearance and apical touch. There were minimal striae present centrally which is not surprising based on the fact that he has keratoconus.
There did not appear to be any neovascularisation present. I enclose a copy of his corneal topograpyfor your records. The rest of his examination was otherwise normal.

With regards to further management, as he is tolerating his scleral lens and has good vision, he should maintain using this modality . Should he develop neovascularisation or problems with retention of the lens then one might have to consider surgical options. My initial favoured option based on the appearance of his cone would be insertion of Ferrara rings and should this fail then one could consider a deep anterior lamellar therapeutic keratoplasty. I do not believe he is anywhere close to having either of these procedures presently.

I have not made arrangements to see him again in follow-up however shall be more than happy to do so should the need arise.

With many thanks and kind regards
Yours sincerely,

Sheraz M Daya, MD FACP FACS FRCS(Ed)
Director and Consultant Ophthalmic Surgeon
Corneoplastic Unit and Eye Bank