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Scleral contact lenses in the pediatric population-Indications and outcomes
Boris Severinsky1, Phoebe Lenhart2
1Specialty Contact Lens Service, Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Road, NE, Suite 3506, Atlanta, GA, 30322, United States.
Insights
Custom scleral contact lenses (SL) successfully treated pediatric patients with complex eye conditions, improving vision and protecting ocular surfaces. Long-term wear was achieved despite fitting challenges, offering a valuable alternative to surgery for conditions like keratoconus.
Area of Science:
- Ophthalmology
- Optometry
- Biomedical Engineering
Background:
- Pediatric eye conditions often require specialized visual rehabilitation and ocular surface management.
- Scleral contact lenses (SL) offer a unique solution for complex visual and ocular surface issues.
- Limited data exists on the efficacy and outcomes of custom SL in pediatric populations.
Purpose of the Study:
- To evaluate the use and outcomes of custom-designed scleral contact lenses (SL) in treating pediatric patients.
- To assess the effectiveness of SL in visual rehabilitation and ocular surface protection for children.
- To identify indications, complications, and long-term wear success in pediatric SL users.
Main Methods:
- Retrospective review of medical records for pediatric patients (under 15 years) fitted with SL between March 2018 and February 2020.
- Data collected included ophthalmic diagnosis, surgical history, lens-wearing failures, and duration of use.
- Analysis of patient demographics, refractive data (keratometry), and treatment outcomes.
Main Results:
- Eighteen pediatric patients (24 eyes) were fitted with custom SL for refractive errors (keratoconus, aphakia) and ocular surface diseases (neurotrophic keratitis).
- SL obviated the need for keratoplasty in eyes with advanced keratoconus and traumatic corneal scarring.
- Fifteen patients (83%) achieved successful long-term scleral lens wear with a mean follow-up of 9.2 months; complications were minimal.
Conclusions:
- Custom scleral lenses are effective for visual rehabilitation and ocular surface protection in pediatric patients.
- Children with advanced keratoconus and traumatic corneal scarring significantly benefit from scleral lens wear.
- Despite fitting and training challenges, long-term scleral lens wear is feasible and successful in pediatric populations.
Purpose:
To report the use of a custom-designed, scleral contact lens (SL) in the treatment of pediatric patients.
Methods:
The medical records of all patients under 15 years of age fitted with SL from March 2018 through February 2020 were retrospectively reviewed. Ophthalmic diagnosis, prior surgical intervention, lens wearing failures, and duration of lens use are reported.
Results:
Lenses were dispensed to 18 patients (24 eyes). Main indications for SL fitting were refractive error correction (n = 18: keratoconus (KCN), traumatic corneal scarring, corneal transplant status, and aphakia) and ocular surface protection and optimization (n = 6: neurotrophic keratitis and chronic blepharokeratoconjunctivitis). Patient age ranged from 16 months to 14 years (mean, 9.9 ± 3.5 years (mean ± standard deviation (SD)). Patients fitted for surface disease indications were significantly younger, 8.8 ± 2.5 years. The mean maximal keratometry reading in patients with keratoconus was 64.0 ± 12.6 diopters (D). In six eyes with advanced KCN (Kmax 71.8 ± 11.0 D) and three eyes with traumatic scarring, SL use obviated the need for keratoplasty. Fifteen patients (83 %) continued scleral lens wear with a mean follow-up period of 9.2 ± 7.4 months. Complications included one case of corneal graft rejection and one corneal abrasion associated with lens insertion.
Conclusions:
The goals of SL fitting in pediatric patients are visual rehabilitation and ocular surface protection. Pediatric patients with advanced keratoconus and traumatic corneal scarring are most appreciative of the benefits of scleral lenses. The challenges associated with SL fitting and the training process did not preclude long-term SL wear.
