Scleral lens indications are well established in published literature,
beginning with descriptions of blown glass shells that were the precursors of scleral
lenses in the late 1800s. Fick and Kalt explored the potential for optical correction of
corneal irregularity in keratoconus with their original lenses, while Mueller described
the use of a blown glass shell to correct significant myopic refractive error.
Publications predating the introduction of rigid gas permeable scleral lenses in 1983
described the use of molded scleral shells or lenses to improve vision in cases of
significant corneal irregularity, to protect the ocular surface and to correct refractive
error. The introduction of rigid gas permeable contact lens materials sparked renewed
interest in the scleral lens modality. Since Ezekiel’s description of the use of rigid gas
permeable scleral lenses in the management of keratoconus, high ametropia, marked
corneal scarring and corneal surface compromise in 1983, interest in scleral lenses has
steadily grown.
Whenever a scleral lens is placed on a diseased eye, practitioners must be aware that it
is a therapeutic medical device. Use of scleral lenses in the management of ocular
disease requires an understanding of the disease process. The eye should be monitored
carefully to see that the desired outcome is obtained, and the therapeutic approach
should be adjusted if the expected outcome is not achieved or if unexpected
complications arise. Cooperation and collaboration with other eye care providers and
specialists within other areas of medicine will allow practitioners to maximize the
benefit for our patients.
Keywords: Auto-immune diseases, Clinical populations, Corneal ectasia, Corneal
scars, Cosmetic, Dryness, Indications, Irregular corneas, Keratoconus,
Keratoglobus, Managing expectations, Ocular surface, Ocular surface protection,
Optics, Pellucid marginal degeneration, Post-corneal transplant, Prosthetic,
Risk/benefit, Secondary corneal ectasias, Trauma.
