Scleral lens prescribing trends in a large specialty contact lens practice in the Netherlands.

Purpose: To report scleral lens prescribing trends in a large specialty contact lens practice in the Netherlands.

Methods: In this retrospective cohort study, data of all scleral lens orders between 2016 and 2022 were collected. Patient demographics, scleral lens design, scleral lens parameters and one lens order per eye per fitting period were analysed. All scleral lenses were fitted using the Visser fitting philosophy with diagnostic trial sets.

Results: In total, 27,430 scleral lenses for 6,635 unique patients were evaluated, of which 2,594 unilateral cases, 16,685 mini-scleral lens designs (60.8 %) and 10,745 large scleral lens designs (39.2 %). Median patient age at the time of the initial order was 43 years (range 3-95) and 53.4 % were male. Keratoconus patients were the youngest group (median 35 years, range 9-83). For all indications, except for keratoplasty, the proportion of mini-scleral versus large scleral lens design increased significantly over time (44 % in 2016, 74 % in 2022). The ratio of tangential versus curved landing zones was 10:1 in mini and 1:1 in large scleral lens design. Both lens design landing zones were toric in 99.8 % of all cases. The median (range) flattest tangent of the landings zone was 38 (16-58) degrees (mini-scleral lens design) and 44 (37-53) (large scleral lens design). The median (range) flattest curve of the landing zone for the large scleral lens was 12.5 (10.5-13.8). Median sagittal depth was 3.5 versus 4.3 mm, median BOZR was 8.6 versus 8.2 mm and median diameter was 16 versus 20 mm in mini and large scleral lens designs, respectively. The mean number of lenses (±SD) ordered for a successful new fit for all designs combined was 1.4(±0.7).

Conclusion: A notable result of this study was the predominant use of toric scleral lens landing zones. During the study period the prescribing trend shifted from large towards mini-scleral lens designs. The fitting strategy with diagnostic trial sets resulted in high success rates with low numbers of re-orders.