Scleral shell prostheses in patient care: A survey of eyecare clinicians in New Zealand.

Abstract

Purpose: Research to guide scleral shell practice is sparse with minimal evidence-based information available about indications and contraindications for shell wear, or the ideal wear and maintenance regimes. New Zealand optometrists, ophthalmologists and ocular prosthetists were surveyed to gauge current understanding.

Methods: Topics queried included practitioner specialisation, judgements on the suitability and success of shells for different presentations of non-functional disfigured eyes, shell wear and maintenance protocols, and management of complications.

Results: Responses from 140 optometrists, 50 ophthalmologists and 8 ocular prosthetists were collected. Optometrists and ophthalmologists observed that patients with non-functional disfigured eyes had an ocular prosthesis significantly less often than anophthalmic patients (∼30 % vs >90 %). Judgements from optometrists and ophthalmologists about shell suitability for different clinical presentations were wide ranging and inconsistent. Judgements from ocular prosthetists highlighted globe volume, corneal sensitivity and corneal integrity as key factors determining shell wear success. Keratitis and discomfort with shell wear were of high concern to both optometrists and ophthalmologists. Optometrists and ocular prosthetists most frequently reported that shells should be disinfected daily with no overnight wear, while ophthalmologists provided heterogeneous recommendations.

Conclusions: There are significant inconsistencies among and between ophthalmologists and optometrists in the provision, care and maintenance of scleral shells. Ocular prosthetists in New Zealand do not have the necessary scope of practice to care for patients' eye health once they have fabricated and fitted a scleral shell. The consequence of these combined factors is that people with blind disfigured eyes in New Zealand are sub-optimally managed. This survey provides a foundation for developing interdisciplinary consensus guidelines on scleral shell provision and maintenance in New Zealand.