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The Healing Power of the Scleral Lens

The two photos below are of the left eye of a patient who suffered significant trauma to his body, face and left eye in a car accident. This patient’s upper left eyelid was severed from flying glass. His left cornea had numerous particles of glass which nearly perforated his cornea, but did create a purulent corneal ulceration. Two months ago reconstructive surgery was performed on this patient’s left upper eyelid. One month ago I fit this eye with a scleral lens to protect it from the environment and the blinking action of the eyelid. 7 days ago I refit this eye with a very thin gas permeable scleral lens made with a highly oxygen permeable material that is FDA approved for wear during sleep. Because this patient is unable to close his left eye completely, I asked him to wear this lens during sleeping hours as well as during the his waking hours. He has been wearing this lens all day while taking short breaks during the day to remove the lens, rinsing out his eye with saline solution, cleaning the lens and reinserting it. Look carefully at the photos below. The first photo was taken one month ago when I first met this patient and placed a scleral lens on this eye. Note the inflammation, mucous formations and the opaque, cloudy cornea. At the initial visit, this patient’s best corrected visual acuity was finger counting. The 2nd photo was taken yesterday. Note how much clearer his cornea is. In the 2nd photo you can see his pupil which is barely visible in the first photo. Also note the improved appearance of his upper eyelid in the 2nd photo. With this very thin highly oxygen permeable scleral lens, this patient’s corrected visual acuity is now 20/150. The oculoplastic surgeon who I share this patient with was as surprised as i was at the degree of improvement in such as short period of time. Three months before I met this patient, he was told by a very prominent eye specialist that this eye needed to be removed. Fortunately he and his family decided to obtain another opinion. This patient’s story, his eye and his scleral lens “journey” with me has to be one of the most unforgettable experiences of my career.


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SMAP 3D Scleral Lens Design

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure
the ocular curvatures outside the cornea. The SMAP allows us to do this. Because the scleral lens rests on the white portion of the eye it is very important to have this information. Most eyes have scleral surfaces that are asymmetric. That is. the scleral curves vary depending on what part of the white portion of the eye your are looking at. These surface curvatures also vary between eyes of the same patient. The SMAP measures over 1 million points along the ocular surface with a precision of less than 10 microns. We are even able to obtain scleral surface measurements beneath the eyelids. The information provided by the SMAP allows us to design a scleral lens with the back surface curvatures of the scleral lens matching the front surface curvatures of each individual eye.

To obtain a 3 dimensional image of the ocular surface, 3 separate images are taken of each eye, with the patient looking in a different direction with each image taken. The 3 images obtained are stitched together to obtain on 3 dimensional image. These images are uploaded to our scleral lens lab where special computers are able to create a scleral lens where every aspect of the patient’s ocular surface is replicated onto the back surface of the scleral lens. The vision and comfort provided to our patients is always excellent with all day comfortable lens wear.

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