Sclerals — fitting ease is game changer

Scleral lenses have been around for over 100 years but for much of the time were seen as the province of specialist practitioners, or hospital eye departments. Early polymethyl methacrylate (PMMA) lenses were effective but could only be worn for short periods (of several hours) due to their lack of oxygen permeability. In recent years there has been a resurgence of interest in the fitting of this modality, partly brought about by the arrival of gas permeable materials, but mainly by a better understanding of the shape of the eye itself.

OCT imaging has shown us that the change in shape at the limbal junction is much more discreet than previously thought, and also the sclera itself is not uniform in shape (see Figure 1).