I spent much of last week in a meeting with the Contamac group in Cambridge. They had assembled a group of specialist contact lens practitioners, both optometrists and ophthalmologists, from around the world with the aim of debating a number of issues of current significance in the world of rigid lens fitting. One topic of note was the dramatic increase in scleral lens fitting, particularly in the US where it is the fastest growing segment of the gas permeable lens market.

I remember back in the late 1980s (I am getting so old), struggling to create an impression moulding on a fellow student at Aston with the aim of then creating a scleral lens. The process seemed as complex as it was archaic and I assumed it was being taught for historical interest only.

When later at Moorfields, I remember sitting in on a many a healthy debate between optometrists and ophthalmologists where few were championing the scleral lens as a viable option for patients other than those with extreme corneal disfigurement. Chief among those arguing for the benefits of gas permeable scleral lenses was Ken Pullum who, it is reassuring to see, has been vindicated in his belief in the modality after many years in the wilderness.

The recent renewed interest in sclerals has a number of underlying factors. Firstly, the improvements in fitting set designs. Furthermore, there is increased access to topographers, though anterior OCT assessment of empirical fitting has also improved the process.

The average number of trial lenses for successful fit is now under two among practitioners regularly fitting sclerals. Add to this, patient testimonials of stable vision and good comfort, along with advances in materials (including the new HydraPeg coating) and it would seem that sclerals and mini-sclerals should now again be in the practitioner’s armoury for fitting the general population.