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Surgical Scleral Lens-EB150

Lens Selection

Calculate the patient's "average" "K" reading and go slightly steeper for initial lens selection.

Insertion

  • During the diagnostic procedure it is important to eliminate air bubbles that might become "trapped" between the cornea and the contact lens.
  • Always clean the contact lens with an approved gas permeable cleaning solution.
  • Rinse cleaning solution from the lens.
  • Balance the lens, concave side up, between your index finger and your forefinger.
  • Dip a Fluorescein strip into the solution pooled in the lens; this step allows you to evaluate the base curve and corneal relationship.
  • Have the patient look straight down, so that their face is parallel to the ground.
  • With lens still on your fingers, position your hand between the ground and the patient's eye.
  • The goal is to get the solution to displace any air that could get trapped in the lens.

Lens & Fluorescein Evaluation

  • The contact lens should be allowed to settle on the eye for at least 5-10 minutes before beginning the evaluation.
  • The lens should position centrally.
  • The lens should demonstrate about .5mm of movement with the blink.
  • There should be no peripheral seal off, if there is, a noticeably dark ring within the mid-periphery area will be apparent.
  • There should be no sign of conjunctival drag: to check for this look through the edge of lens and focus on a blood vessel in the conjunctiva. Have the patient blink; if that blood vessel moves with the blink then the lens is too tight.
  • The lens should exhibit "vaulting" over the limbal margin.
  • Once a good base curve corneal relationship is established perform a spherical over-refraction for best acuity.

Problem Solving

  • If air bubbles are present, flatten the base curve by 1.00 diopter, continue the process until minimal vaulting or light feathering is present.
  • If there is conjunctival drag, you should flatten the base curve.
  • If the lens demonstrates seal off (a 360 degree ring of touch is present and near edge of the lens) flatten the base curve.
  • If there is excessive central bearing, you should steepen the base curve to liftoff cornea.
  • If you have excessive edge standoff and there is no conjunctival drag, you should steepen the base curve.

Click on the links below to view photos of Scleral Contact Lenses on different types of corneas

1) Scleral Contact Lenses and Post Surgical Corneas

2) Scleral Contact lenses and Corneal Ectasis

3) Scleral Contact Lenses on some unsual eyes