AAO Academy Online
IPoster: Management of Corneo-Scleral Irregularities with Virtually Designed Custom Multi-Meridian Scleral Lenses
Introduction: Toric haptic scleral lens designs are prescribed more often than in previous years. Recent interest in mapping the sclera and conjunctiva is proving that scleral shape is highly variable, and may explain the difficulty in fitting some patients with scleral lenses. A corneo-scleral topographical system was utilized to evaluate ocular shape of two patients. Custom multi-meridian back surface toric haptic scleral lenses were empirically designed to address the unusual scleral shape, which significantly deviated from a sin2 bitoric curve with a periodicity of 180°.
Case Reports: Case 1 had central corneal scarring due to recurrent herpes zoster and poor fitting scleral lenses, resulting in inferior decentration. Scleral topography showed a largely flat sclera with the exception of a 120° wide area of depression (~500µ deep) centered at 320°. A custom lens was designed to conform to this inferior depression which was well centered, comfortable, and provided better vision than previously obtained.
Case 2 had advanced keratoconus with corneal ring implants and poor fitting scleral lenses, resulting in a recurrent corneal ulcer overlying bulging edge of the right ring implant, and lens intolerance. Scleral topography showed high scleral/conjunctival toricity, but with the steep axis inferiorly (270°) having a SAG 500µ greater than the steep axis superiorly (70°). A custom lens was designed to conform to this irregular scleral shape which had an optimal fit per OCT and slit lamp evaluation, was comfortable, and provided excellent acuity.
Conclusion/Discussion: The novel topography device and innovative software technology accurately mapped both corneal and scleral irregularities, empirically designed the scleral lenses, and accurately predicted the fit and fluorescein patterns. These virtually fit scleral lenses provided both patients with good comfort and vision they did not experience with previous lens designs.