Management of ocular surface irregularity with scleral contact lenses: Experience from a tertiary eye care center

Purpose: This review focuses on the optical and therapeutic benefits which can be offered to patients by evaluating them for scleral contact lenses, and the purpose of this study is to select the indications and to find out how efficient the scleral contact lenses are in treating severe corneal ectasias, highly irregular astigmatism and ocular surface diseases (OSDs) which are otherwise difficult to manage. This retrospective observational case series study analyzed a database of 50 consecutive patients (69 eyes) fitted with scleral lenses between January 2017 and December 2019. All consecutive eyes which were given scleral contact lens trials were analyzed. Results: The study population included 34 males and 16 females, with ages ranging from 7 to 80 years. The mean follow-up was 12 months. The mean wearing time in the successful wearers group was 12.2 hours per day (range 10–16). Vision improvement (optical purpose) was the reason for the fitting in 48 eyes (67.60%), and OSD management (therapeutic purpose) in 23 eyes (32.39%). In the former group, 56.52% (n = 26) had keratoconus, and 43.48% (n = 20) had irregular astigmatism other than keratoconus. Among the OSD patients, 56.52% had Steven Johnson syndrome (SJS) sequelae, 17.39% had severe dry eye, 17.39% had chemical injury sequelae, and 8.69% had xeroderma. Keratoconus patients achieved visual acuity of more than 20/32 in 92.3% of eyes. Among the SJS patients, 69.23% had more than 20/40 (38.46% had 20/20). Conclusion: There is compelling evidence in the literature that scleral contact lenses can provide good results for the challenging patient groups described in this review. We have experienced that scleral contact lenses expand the management of corneal pathologies, especially in OSDs.