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      Scleral lenses: a literature review.

      Eye & Contact Lens
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          To present a comprehensive review of current and historical literature on scleral lenses.

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          Most cited references126

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          Gas-permeable scleral contact lens therapy in ocular surface disease.

          To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease. The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjögren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting. Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.
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            Contact lenses in the management of keratoconus.

            The range of contact lens modalities currently available for the successful optical correction of keratoconus is greatly expanded. We review lens types currently available for the nonsurgical management of keratoconus, including rigid gas-permeable (GP) lenses, intralimbal lenses, corneoscleral lenses, scleral lenses, hybrid lenses, and piggyback lenses. In this review, we discuss the contemporary range of available lens types and the circumstances in which they are best used.
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              Modern scleral contact lenses: A review.

              Scleral contact lenses (ScCL) have gained renewed interest during the last decade. Originally, they were primarily used for severely compromised eyes. Corneal ectasia and exposure conditions were the primary indications. However, the indication range of ScCL in contact lens practices seems to be expanding, and it now increasingly includes less severe and even non-compromised eyes, too. All lenses that partly or entirely rest on the sclera are included under the name ScCL in this paper; although the Scleral Lens Education Society recommends further classification. When a lens partly rests on the cornea (centrally or peripherally) and partly on the sclera, it is called a corneo-scleral lens. A lens that rests entirely on the sclera is classified as a scleral lens (up to 25 mm in diameter maximum). When there is full bearing on the sclera, further distinctions of the scleral lens group include mini-scleral and large-scleral lenses. This manuscript presents a review of the current applications of different ScCL (all types), their fitting methods, and their clinical outcomes including potential adverse events. Adverse events with these lenses are rare, but the clinician needs to be aware of them to avoid further damage in eyes that often are already compromised. The use of scleral lenses for non-pathological eyes is discussed in this paper.
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                Author and article information

                Journal
                25536528
                10.1097/ICL.0000000000000083

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