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Modern scleral lenses: Mini versus large.

¹Private practice, Italy.

Contact Lens & Anterior Eye : the Journal of the British Contact Lens Association

|May 15, 2017

Summary

Choosing the right scleral lens diameter is key for successful fitting. This review compares mini and large scleral lenses, offering guidance on selecting the optimal diameter based on patient factors and potential issues.

Keywords:

Diameter Horizontal visible iris diameter Landing zone Large scleral Limbus Mini-scleral

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Area of Science:

Ophthalmology
Optometry
Biomedical Engineering

Background:

Scleral lens designs and fitting concepts have evolved, with modern lenses featuring smaller diameters than original designs.
The distinction between smaller and larger mini-scleral lenses necessitates clear definitions based on landing zone width relative to horizontal visible iris diameter (HVID) and limbus extension.

Purpose of the Study:

To review the benefits and disadvantages of mini and large scleral lenses.
To analyze conditions favoring the selection of one scleral lens diameter over another.
To propose a starting point for scleral lens diameter selection.

Main Methods:

Literature review of scleral lens fitting concepts, designs, and diameter selection criteria.
Analysis of factors influencing scleral lens diameter choice, including patient topography, anatomy, oxygen supply, and ocular surface health.
Comparison of mini and large scleral lens applications.

Main Results:

Scleral lens diameter selection is crucial and depends on patient-specific topographic and anatomic factors.
Key considerations for diameter choice include oxygen permeability, bubble formation, mechanical stress, ocular surface protection, corneal vault, and weight distribution.
Mini-scleral lenses offer advantages, but larger lenses are sometimes necessary.

Conclusions:

A suggested approach is to start with the smallest possible scleral lens diameter, guided by HVID and limbus width.
Larger scleral lens diameters should be considered only when issues arise with smaller lenses.
Optimal scleral lens diameter selection balances patient-specific needs with lens performance and comfort.