We had a very nice patient arrives for her scleral lens follow up this week!
This patient was kindly referred by Dr. Stafeeva from New Eyes for a scleral lens refit. This patient has ocular pemphigoid and severe dry eyes. She also suffers from a condition called Sjögren’s syndrome. Patients with Sjögren’s have incredibly dry eyes, and many patients require the use of scleral lenses to function. Scleral lenses hold a layer of liquid onto the eye surface all day, creating a barrier between the eye and the outside world. This results in eye relief and reduced redness, pain, and dry eye symptoms. Many patients must insert their scleral lenses first thing in the morning to even be able to function.
Her habitual scleral lenses were fit elsewhere about 2 years ago. She has done very well over the past 2 years, but as the lenses have worn down, there are some scratches and multiple deposits.
You can see that the edges of the lenses are also a bit compressed, so we felt there could be an improvement to the lens fit as well. In the photo of her old scleral contact lens, you can see there is a bit of white color near the edge of the lens landing. This is called compression and it means the edge of the lens is squishing the conjunctiva or sclera. This compression can cause the eyes to become red after a few hours of wear. It can also cause a compression ring around the sclera when the lens is removed. Many patients will complain that there is a large ring around their eye when the lens is removed.
The photos also show that her old lens had a very large amount of deposits. Deposits can be from excess protein, lipids, and mucous in the tear film on the ocular surface. These can stick onto the lens, creating a blurry image. Deposits on the contact lenses can also cause discomfort. When traditional remedies do not work, it is often times necessary to change the material of the scleral lens or add a special coating.
After reviewing all of the options, we decided to proceed with the Latitude custom scleral lens. The Latitude is very custom lens because we take 3 D images of the entire eye surface, and then the lab is able to fabricate a very custom scleral lens. We felt this was the best option for her.
She had some symblepharon on the upper conjunctiva on each eye, which made some of the images difficult to capture, but we did our best and took multiple images.
The laboratory fabricated the lenses based on the images sent and the diagnostic lens fitting information.
The Latitude custom scleral lenses are fitting much better than her habitual lenses, and we added Hydrapeg coating to help with deposit resistance and to improve wettability. Hydrapeg coating helps with dry eye issues and also helps resist deposits on the lenses. Hopefully by adding this coating, the patient will not have an many deposits on this pair of lenses. Patients with ocular surface disease such as dry eye syndrome, Sjögren’s, Stephen Johnson, ocular pemphigoid or graft vs host disease may always suffer from deposits on the lenses, no matter what changes we make. This is because the tear film and the ocular surface are abnormal, creating a non wetting surface or deposits on the lenses. For these patients, it is important to manage their dry eye disease at the highest level.
Thanks again to Dr. Stafeeva for thinking of us to help with this fun case!
