scleral lens help

[lasikmonkey]

can I ask, other than Ken Pullum, who does scleral lenses in the uk?

does any one specialise in aberrometry? i.e. wavefront optics with sclerals?

[Anne Klepacz]

A number of the NHS hospitals with large contact lens departments (eg Moofields, Birmingham, Glasgow and others) will fit patients with scleral lenses if other (cheaper!) lens options don't work for that individual.
I don't know the answer to your other question but if you contact Innovative Sclerals (you'll find them in the links on our home page) they may be able to tell you.
Anne

[GarethB]

I think Ken's Innovative Sclreals are the only UK manufacturuer, but may not be the only supplier in the Uk to provide these lenses to UK hospitals.

As far as I am aware wave front optics is something used on the Keraoft range of lenses but if I recall correctly wavefront refers to the side of the contact lens that the power is applied to, so wave front means the front of the lens.

Unsure what difference this would make to a sscleral that vaults the KC cone.

On corneal lenses it makes a big diffrence because the lens power has no affect on the geometry of the back lens surface that is trying to give a uniform shape the the cornea I believe.

[sophietw]

Hi lasikmonkey,

There are a few manufacturers besides Ken of mini-scleral type lenses, around the 14mm diameter mark, and there is a new lens design just been launched called ICD ('irregular cornea design') which are 16.5mm diameter, and can vault most irregularities. They are very new so you may have to wait a while for someone in your area to start fitting them. I fit them, as I have been 'testing' them for the past 18 months. They're pretty good. But if you're after full sclerals (22mm+) then Ken is your man.

I don't think wave-front type lenses are around just yet. I can't get my head around how they will work because it will rely on the lens remaining perfectly still and never rotating at all, even 0.5mm off and the aberration control will be zero. But who knows? Maybe one day!

Sophie

[Ali Akay]

Scotlens in Edinburgh do an 18mm mini scleral lens which can work work well. I've used it a few times with good results. They look less intimidating than the full sclerals! I am sure Scotlens could advise you the nearest fitter in your area. I am going to a seminar next week about the new ICD lens Sophie has mentioned . It sounds promising, we'll have to wait and see!

[DrG]

I just stumbled onto this thread about wavefront scleral lenses. I realize this is an old thread but it is a topic near and dear to me.

They are being made, but mostly in the university research setting in the U.S. I have been putting wavefront guided correction into scleral lenses for quite awhile and have just been granted patent approval for this in the U.S. It is true that the lens must be rotationally stable, and this is done using another process I have invented that utilizes OCT scans to map the anterior surface of the eye, and then creating a lens from those scans using sophisticated computer-aided design software. The result is a lens that does not rotate and centers extremely well. The surface of the lens is altered using readings from an aberrometer, i.e. Zernike coefficients. The result is typically between 1 to 2 lines of Snellen improvement in vision according to my data. Other optical techniques are employed as well.

Most keratoconus patient will show elevated higher order aberrations, mostly coma, even with scleral lenses. Wavefront-guided lenses can vastly improve the quality of vision. I will link to my website should anybody have further interest as there are some case studies. I've been working hard on these technologies for a number of years and as a result have published little. My last article was 2008 in Eye & Contact Lens about using OCT scans to design scleral lenses. Thanks.

http://www.globalrefractivesolutions.com/wordpress .

[DrG]

Just another example of how wavefront-guided scleral lenses can make a difference. This gentleman had moderate keratoconus in one eye and mild keratoconus in the other. He was corrected to 20/30 with spectacles in the worse eye (20/60 uncorrected). With a standard scleral lens he was still 20/30 because of residual coma. A wavefront guided lens got him to 20/15 in the worse eye and 20/10 in the other eye. This was measured using a near Snellen chart held at 32 inches instead of the standard 16 inches. On the link there is a table of the higher order aberrations of his unaided eyes, with standard lens, and with wavefront-guided. Not everybody gets these results, but most get improvement on the order of 1 or more lines of acuity. Other academic researchers have shown similar results for improvement of the aberrations (halos, glare, double vision, etc.) with wavefront-guided sclerals, and those results have been published (Yoon, Marzak, Applegate). Of course I realize that patients would trade comfort for vision in most cases, but what if they can get both? Interesting stuff coming down the pike...

http://globalrefractivesolutions.com/wo ... al-lenses/

[DrG]

Just wanted to bump this topic back up. We just got awarded our patent from the U.S. Patent and Trade Office for our version of a scleral lens with wavefront-guided optics. This helps to reduce some of the effects of glare and other distortion that is present even with contact lenses for many keratoconus sufferers.

Just to re-iterate, we have another patent on the design and fitting of the scleral lenses from OCT scanning devices. This eliminates the need for the old trial lens method. We create a digital model of the eye and design a lens from scratch to fit the eye using best in class software.

I've gotten inquiries from some of you regarding availability of this technology in the UK. As of yet there are no firm plans along those lines. Our technology was recently featured in the U.S. publication Medical Design Technology http://www.mdtmag.com/articles/2014/01/restoring-sight-laser-fit-lenses.

[DrG]

Please visit our new website: www.laserfitlens.com . Some good articles, case studies, and other things involving our patented scleral lenses. Please like us on Facebook and follow us on Twitter.

[DrG]

I have had a number of UK patients over the years, primarily for post-LASIK or RK issues. Today I finished up with my first UK keratoconus patient who found out about us right here on this forum. YAY! I am quite proud of the results, and he seemed quite pleased as well. Needless to say, he felt that he had exhausted all of the other options, including CXL. I found it surprising that so much skepticism exists, not only in the UK, but elsewhere regarding this technology, but more papers are being published that clearly show the benefits.

I plan to post a case report soon on the website: http://www.laserfitlens.com .