Top 10 complications of scleral lenses

The use of scleral lenses is increasing as new materials and designs make them the preferred option in many therapeutic and refractive management cases. In this three part series, we will look at the latest designs and materials and then the fitting techniques to best ensure successful wear. But to launch the series, we will review my list of 10 complications which, I hope, will provide a useful starting point for those aiming to gain experience in this rewarding area of contact lens practice.

It’s funny how fashions always seem to come back around. Contact lenses started big, restricted as they were by manufacturing methods. They then became smaller as the ability to lathe cut plastic lenses came along, as well as a better understanding of the oxygen requirements of the cornea. Even when materials advanced and became close to 99% permeability to oxygen, rigid lenses remained ‘small’, as this was what we became used to and adept at fitting. Larger scleral lenses became the domain of a few keen specialists, and developed a reputation for being very ‘niche’ and difficult to fit, only to be attempted by the very experienced. However, in the last 10 or so years I have noticed a slow trickle of mini-scleral and scleral lenses come onto the market, some originating in the US and some designed here in the UK. They have slowly gained in popularity as practitioners’ confidence in fitting such lenses has grown, and there is a clear benefit to both clinician and patient.