Scleral Lens Wear Research Articles

Evaluation of meibomian gland morphology in keratoconus patients wearing scleral contact lenses.

We aimed to evaluate the morphological changes in meibomian glands in keratoconus patients using scleral contact lenses and compare them with keratoconus and healthy controls. The study included 34 eyes of 20 patients who were wearing scleral contact lenses due to keratoconus, as well as 31 age- and sex-matched keratoconus controls and 31 healthy controls. Slit-lamp biomicroscopy, non-invasive tear film break-up time assessment, Schirmer I test, meibography, and corneal staining with fluorescein were performed. Subjective symptoms were assessed using the Ocular Surface Disease Index. In this study, the lower and upper percentage meibomian gland loss was statistically higher in the scleral contact lens group than in the keratoconus and healthy control groups (p < 0.001 and p = 0.013, respectively). There was a positive correlation between scleral contact lens wear duration and the lower eyelid percentage meibomian gland loss and upper eyelid gland curling scores (rho: 0.396; p = 0.021 and rho: 0.344; p = 0.047, respectively). The lower and upper eyelid percentage meibomian gland loss, and upper eyelid gland curling values were higher, and the Schirmer 1 values were found to be lower in patients who used scleral contact lenses for more than three years than those who wore them less than three years. In patients using scleral contact lenses for more than three years, meibomian gland curling values and percentages of meibomian gland loss in both eyelids are higher.

Scleral lens fitting after paediatric limbal dermoid removal

Purpose. This case report describes the management of refractive error and amblyopia using a scleral lens fitted to the eye of a young child with an irregular cornea resulting from limbal dermoid removal and corneal transplant in infancy. Material and Methods. A young infant was initially fitted with spectacles and occlusion therapy following the surgical excision of a limbal dermoid and full thickness corneal transplant. The vision did not improve in spite of patching so the child was referred for contact lens fitting. Various iterations of scleral lens fitting were carried out. Results. Scleral lens fitting was attempted from the age of 2 years but transplant rejections, the COVID-19 pandemic and variable cooperation meant that adequate lens wear could not be achieved in the early stages. In addition, the corneal shape changed during the course of the fitting. During these periods, spectacle wear and occlusion therapy were maintained until a good lens fit could be achieved following several modifications. Treatment is ongoing but at the age of 5 years, the visual acuity is 0.24 logMAR letters. Conclusion. Scleral lenses can be used to habilitate the vision in an eye with an irregular cornea but when scleral lens wear is not possible, it is important to persevere with spectacle correction and patching therapy. Several iterations of scleral lenses may be needed as the eye changes and the child grows.

Short-term changes in the trabecular iris angle and anterior chamber during wear of scleral lenses with different diameters

ABSTRACT Clinical relevance Scleral lens (SL) compression on the conjunctiva/episclera during wear may alter adjacent structures related to aqueous humour drainage. Background The aim of this work was to assess short-term changes in the four quadrants of trabecular iris angle (TIA) and anterior chamber parameters during SL wear, using anterior segment optical coherence tomography (AS-OCT). Methods Prospective study was conducted involving 16 healthy subjects with a mean age of 28 ± 5 years. Two SL of diameter 15.80 mm (L1) and 16.80 mm (L2) with the same parameters were used for 2 hours in different days. The central fluid reservoir (FR), the TIA in superior, inferior, nasal, temporal quadrants, and anterior chamber parameters; anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber area (ACAr) and anterior chamber volume (ACV) were measured with AS-OCT. These measurements were performed immediately after SL application (0 h), one hour (1 h) and two hours (2 h) of SL wear. Results TIA decreases significantly in the superior quadrant at 2 hours of L2 wear (−5.19 ± 7.79º) (p = 0.04). In this sector, differences were also observed between the changes induced by both lenses during the 2 hours of wear (p = 0.04) and between first and second hours of wear (p = 0.04). ACD was significantly lower with L1 (−0.09 ± 0.14 mm) relative to L2 (0.00 ± 0.06 mm) between immediately after the application and 2 hours of wear (p = 0.02). A significant reduction in ACAr at 1 hour (−0.65 ± 0.75 mm2) (p = 0.01) and 2 hours of wear (−0.81 ± 1.15 mm2) (p = 0.04), as well as in ACW at 2 hours (−0.11 ± 0.14 mm) (p = 0.02) compared to immediately after application of L1 was found. Conclusion Small changes in TIA and anterior chamber occur during two hours of SL wear, but these changes are of limited clinical relevance in healthy subjects.

Changes in anterior segment after short-term scleral lens wear in healthy Chinese population

PurposeTo evaluate the impact of short-term scleral lens (SL) wear on anterior chamber (AC) dimension and central corneal thickness (CCT) in healthy Chinese people. MethodsThis is a prospective, daily wear study. Eligible participants were dispensed SLs to correct refractive errors. Anterior segment (AS) parameters were measured by AS optical coherence tomography (AS-OCT) before, during, and after 2 and 4 hours of lens wear. Repeated-measures analysis of variance (ANOVA) was used to analyze the changes in AS parameters over time. ResultsTwelve subjects (10 females and 2 males) with a mean age of 25.3 ± 3.8 years (ranging from 21 to 34 years) were recruited. The AC parameters, including anterior chamber depth (ACD) from the endothelium (endo-ACD), angle opening distance at 500 μm (AOD500), and trabecular-iris space area at 500 μm (TISA500), significantly decreased after wearing SLs for 4 hours (P<0.05). CCT increased by 12 μm (2.29 %) after wearing SLs for 4 hours (P=0.013). ConclusionThis study suggests that SL wear has a significant impact on AS dimensions in patients with healthy corneas in the short term with SL in situ, but tend to recover quickly after SL removal. Further research is needed to determine whether the change in AS dimensions during SL wear affects aqueous humor (AH) outflow and causes changes in intraocular pressure (IOP).

Prospective assessment of corneal biomechanical properties and intraocular pressure during scleral lens wear

Prospective assessment of corneal biomechanical properties and intraocular pressure during scleral lens wear

Impact of scleral lens wear on IOP in a population of irregular cornea patients

Impact of scleral lens wear on IOP in a population of irregular cornea patients

The effect of lens and fitting characteristics upon scleral lens centration.

To quantify the impact of varying central fluid reservoir depth, lens thickness/mass and the addition of a peripheral fenestration upon scleral lens centration. Ten young, healthy adults participated in a series of repeated-measures experiments involving short-term (90 min) open eye scleral lens wear. Scleral lens parameters (material, back optic zone radius, diameter, back vertex power and landing zone) were controlled across all experiments, and the central fluid reservoir depth (ranging from 144 to 726 μm), lens thickness (ranging from 150 to 1200 μm), lens mass (101-241 mg)and lens design (with or without a single 0.3 mm peripheral fenestration) were altered systematically. Scleral lens decentration was quantified using over-topography maps. On average, scleral lens centration varied by <0.10 mm over 90 min of wear. Medium and high initial fluid reservoir conditions resulted in 0.17 mm more temporal and 0.55 mm more inferior lens decentration, compared to the low fluid reservoir depth (p < 0.001). Changes in lens thickness or the addition of a peripheral fenestration did not cause clinically significant changes in centration (<0.10 mm on average) when controlling for fluid reservoir depth. Central fluid reservoir depth was the best predictor of horizontal and vertical lens decentration, explaining 62-73% of the observed variation, compared to 40-44% for lens thickness and mass. Scleral lens decentration remained relatively stable over 90 min of lens wear. A greater initial central fluid reservoir depth resulted in significantly more lens decentration, particularly inferiorly. Large variations in lens thickness, massor the addition of a single peripheral fenestration did not substantially affect lens centration.

ScLNet: A cornea with scleral lens OCT layers segmentation dataset and new multi-task model

ObjectiveTo develop deep learning methods with high accuracy for segmenting irregular corneas and detecting the tear fluid reservoir (TFR) boundary under the scleral lens. Additionally, this study aims to provide a publicly available cornea with scleral lens OCT dataset, including manually labeled layer masks for training and validation of segmentation algorithms. This study introduces ScLNet, a dataset comprising cornea with Scleral Lens (ScL) optical coherence tomography (OCT) images with layer annotations, and a multi-task network designed to achieve rapid, accurate, automated segmentation of scleral lens with regular and irregular corneas. MethodsWe created a dataset comprising 31,360 OCT images with scleral lens annotations. The network architecture includes an encoder with multi-scale input and a context coding layer, along with two decoders for specific tasks. The primary task focuses on predicting ScL, TFR, and cornea regions, while the auxiliary task, aimed at predicting the boundaries of ScL, TFR, and cornea, enhances feature extraction for the main task. Segmentation results were compared with state-of-the-art methods and evaluated using Dice similarity coefficient (DSC), intersection over union (IoU), Matthews correlation coefficient (MCC), Precision, and Hausdorff distance (HD). ResultsScLNet achieves 98.22 % DSC, 96.50 % IoU, 98.13 % MCC, 98.35 % Precision, and 3.6840 HD (in pixels) in segmenting ScL; 97.78 % DSC, 95.66 % IoU, 97.71 % MCC, 97.70 % Precision, and 3.7838 HD (in pixels) in segmenting TFR; and 99.22 % DSC, 98.45 % IoU, 99.15 % MCC, 99.14 % Precision, and 3.5355 HD (in pixels) in segmenting cornea. The layer interfaces recognized by ScLNet closely align with expert annotations, as evidenced by high IoU scores. Boundary metrics further confirm its effectiveness. ConclusionWe constructed a dataset of corneal OCT images with ScL wearing, which includes regular and irregular cornea patients. The proposed ScLNet achieves high accuracy in extracting ScL, TFR, and corneal layer masks and boundaries from OCT images of the dataset.

Scleral lens induced short term corneal changes in eyes with Pellucid Marginal Degeneration

PurposeTo investigate the short-term effect of scleral lens (SL) on corneal curvature and corneal oedema in Pellucid Marginal Degeneration (PMD) eyes. MethodsCorneal anterior, posterior curvature and corneal thickness were measured in 14 eyes of 14 PMD participants with Schiempflug imaging at different corneal diameters and meridians at baseline and after 6 h of SL wear. ResultsThere was a significant flattening (up to 0.26 mm) of the anterior corneal curvature noted in the inferotemporal quadrant (from 210 to 255 degree at 2 mm, 8 mm and 10 mm corneal diameter), inferonasal quadrant (from 285 to 345 degree at 6 mm and 8 mm corneal diameter), and inferiorly at 2 mm and 10 mm corneal diameter (p < 0.05). Similarly, posterior corneal curvature showed statistically significant steepening mostly in inferotemporal quadrants (from 195 to 255 degree from 4 mm to 8 mm corneal diameter) and inferonasally at 2 mm and 4 mm corneal diameter (p < 0.05). A statistically significant increase in the corneal thickness noted in different corneal diameters with corneal oedema ranging from 2.10 % to 4.00 % after 6 h of SL wear. A gradual increase in corneal oedema was noted form centre to periphery. The baseline central fluid reservoir thickness (FRT) was 341.07 ± 139.8 which reduced to 276.71 ± 114.32 µm after 6 h of lens wear. No significant correlation was noted between corneal oedema with different parameters like initial and final FRT, change in anterior and posterior corneal curvature, and lens thickness (p > 0.05). ConclusionsShort-term SL wear induced a clinically acceptable range of corneal oedema. A clinically significant flattening in anterior curvature and minimal steepening in posterior curvature were noted. Practitioners should be careful while measuring corneal parameters in PMD eyes wearing SL, as these alterations can provide false impression of disease progression.

THE PATIENT-PHYSICIAN RELATIONSHIP AND ROLE OF EMPATHIC COMMUNICATION IN CONTACT LENS PRACTICE

Purpose: To assess the relationship between eye care practitioners and contact lens patients and todetermine how empathy is associated with patients’ overall satisfaction.&#x0D; Methods: Multilingual electronic surveys shared by email and on social media in patients’ and practitioners’ groups. Ratings were converted to a numerical scale. The scores were compared using Wilcoxon rank sum tests.&#x0D; Results: The survey had 804 responses: 68.4% were over 46 years old, and 58.1% were female. Only 770 reported the type of contact lens worn. Of all patients, 10.6% would not recommend their physician due to feeling excluded from decisions (55.3%), lack of personal interest (63.5%), no written recommendations (84%), and unmet expectations (77%). Scleral lens wearers were highly satisfied. Optometrists excelled in care, ratings, relationships, communication, symptom relief, and prevention.&#x0D; Discussion: The findings highlight the importance of empathy in eye care and its impact on patient experiences. Factors such as contact lens type, physician recommendation, and physician type can influence the level of empathy perceived by patients. Satisfaction varied based on contact lens type, with soft and scleral lens wearers reporting better experiences. Patients valued physicians who listened, explained treatments, showed empathy, and had patient-centered communication and open-ended questions. Optometrists were scored higher than ophthalmologists in several aspects.&#x0D; Conclusion: Patients, especially scleral lens patients, were generally satisfied with the services and care. Optometrists scored higher than ophthalmologists. Patients would not recommend their physicians mainly because of a lack of empathy.

Lens and solution properties in patients with and without midday fogging.

Midday fogging is a complication of scleral lens (SL) wear that interrupts clear vision during the course of wear. SLs can be made with a variety of gas permeable materials, sizes and surface treatments, and various solutions are available for storing the lenses and for filling them before application on the eye. Many of these factors have been implicated as possible contributors to midday fogging. This study explored the lens and solution properties in habitual SL wearers with and without midday fogging. In this prospective study, 48 habitual SL wearers were evaluated and asked to report whether they experienced midday fogging and if they removed their lenses during the day. They completed the Ocular Surface Disease Index (OSDI), which is a validated tool for dry eye assessment. Lens parameters (material, coatings and diameter) and lens storage and filling solutions were documented. Backward elimination of regression terms evaluated the lens and solution properties in those with and without fogging. OSDI scores were compared using the Mann-Whitney analysis. Collectively, the lens properties and solutions accounted for 27.7% of the variance related to midday fogging. None of the factors alone hada significant impact upon midday fogging. The median (interquartile range) OSDI score for those with fogging [37 (35)] was significantly different from those without fogging [10 (15)], with the scores corresponding to severe dry eye and normal eyes, respectively. SL wearers with midday fogging exhibited similar symptoms to patients with severe dry eye. Lens and solution characteristics may play a small role in patients with midday fogging, although changing just a single factor is not likely to impact its presence.

Aberration change after scleral lens wear in eyes with pellucid marginal degenerations.

To investigate the impact of scleral lenses (SLs) on higher-order aberrations (HOAs), corrected distance visual acuity (CDVA), and contrast sensitivity (CS) in pellucid marginal degeneration (PMD) eyes. SLs were fitted in 24 eyes diagnosed with PMD. CDVA, CS, and HOAs were measured at baseline and with the lens on the eye. The HOAs were measured using an i-Trace aberrometer. A statistically significant improvement was noted in CDVA ( P < 0.001) with BSS lenses (0.05 ± 0.04) compared to baseline (0.42 ± 0.06). Front surface eccentricity 1 (FSE1) lens provided the best CDVA in most of the eyes. The baseline CS of 1.24 ± 0.74 improved to 1.58 ± 0.48 with SL and reported a statistically significant improvement ( P < 0.001) and a gain of 6 letters. The baseline higher order-root mean square (HO-RMS) was 0.89 ± 0.53 µm, which reduced to 0.38 ± 0.24 µm ( P < 0.001), and RMS coma of 0.45 ± 0.29 µm improved to 0.20 ± 0.12 µm ( P < 0.001). Though there was a marginal reduction from 0.04 ± 0.14 to 0.03 ± 0.07, RMS spherical aberration did not show any statistically significant difference ( P = 0.37). RMS secondary astigmatism reduced from 0.17 ± 0.15 µm to 0.08 ± 0.12 µm ( P = 0.007), and RMS trefoil reduced to 0.13 ± 0.09 µm from 0.64 ± 0.36 µm ( P < 0.001) with SLs and showed statistically significant improvement. SLs can be considered an effective option that corrects a significant amount of HOAs and enhances visual performances in PMD eyes.

Anterior, Posterior, and Thickness Cornea Differences after Scleral Lens Wear in Post-LASIK Subjects for One Year.

The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.

Patient Experiences With Therapeutic Contact Lenses and Dry Eye Disease.

To report patient-reported experiences with dry eye disease and therapeutic contact lenses. A survey was distributed to patients with dry eye disease. Demographics, Ocular Surface Disease Index (OSDI), systemic disease, contact lens history, and burden of care information were collected. Descriptive statistics are presented and categorized by nonlens, soft lens, and scleral lens (SL) wearers. Of 639 respondents, 15% (94/639) were currently using therapeutic soft or SLs (47 soft and 69 SL). Mid-day fogging or clouding of vision was reported by SL (75%, 50/67) and soft lens (62%, 29/47) wearers. Seventy-two percent of SL wearers spent more than 20 min daily on dry eye treatment while 43% of soft lens wearers spent more than 20 min. Median annual expenditure was higher for SL ($1,500, n=63) than nonlens ($500, n=371) or soft lens wearers ($700, n=43). Mean OSDI scores in all groups were in the severe category (51±22 years, n=401 nonlens wearers; mean age; 45±22 years, n=47 soft lens wearers; 60±24 years, n=69 SL wearers). Mid-day fogging and blurring of vision was reported by most of the individuals using therapeutic lenses for dry eye disease. SL wearers allocate the most resources for dry eye care.

Prospective assessment of corneal biomechanical properties and intraocular pressure after scleral lens wear: A 12-month follow-up study

PurposeTo investigate the long-term influence of scleral lens (SL) wear on corneal biomechanical properties and intraocular pressure (IOP) in irregular and regular corneas. Secondary goal comprised evaluate the fluid reservoir (FR) thickness overtime and correlate it with the changes in corneal biomechanical parameters and IOP. MethodsSeventy (70) eyes with irregular corneas (IC Group) and 21 eyes with regular corneas (RC Group) were fitted with 16.4 mm SL and wore the lenses for 12 months. Corrected IOP (IOPcc), Goldmann equivalent IOP (IOPg) and corneal biomechanical parameters (Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF)) were measured with Ocular Response Analyzer. Slit lamp images were analyzed with ImageJ software to assess FR thickness overtime. Measurements were taken at lens dispensing visit prior lens wear (LDV1) and after 60 min of lens wear (LDV2) and at 1, 6 and 12-month follow-up visits. Measurements were done immediately after lens removal. ResultsThere were no statistically significant differences on IOPcc, IOPg, CRF and CH over the follow-up visits in both groups. Mean IOPcc and IOPg fluctuations overtime were clinically insignificant and below 1 mmHg in both groups. IOPg, CH and CRF were significantly lower on IC Group (p < 0.001), although no statistically significant differences were found between groups for IOPcc. Regarding FR thickness, statistically significant differences were found over the follow-up on both groups, with a mean decrease of 186.29 µm on IC Group and 175.32 µm on RC Group (p < 0.001). Statistically significant moderate to high negative correlations between FR and IOPg, CRF and CH were found only in the RC Group. ConclusionsLong-term SL wear was not associated to changes in corneal biomechanical parameters neither on IOP as measured after lens removal. Besides IOP measurement without SL removal, more studies are needed to investigate the potential relationship with SL fitting characteristics (namely FR thickness).

Assessment by Optical Coherence Tomography of Short-Term Changes in IOP-Related Structures Caused by Wearing Scleral Lenses.

The mechanism that could increase intraocular pressure (IOP) during scleral lens (SL) wear is not fully understood, although it may be related to compression of the landing zone on structures involved in aqueous humor drainage. Thirty healthy subjects were fitted with two SLs of different sizes (L1 = 15.8 mm, L2 = 16.8 mm) for 2 h in the right eye and left eye as a control. Central corneal thickness (CCT), parameters of iridocorneal angle (ICA), Schlemm's canal (SC), and optic nerve head were measured before and after wearing both SLs. IOP was measured with a Perkins applanation tonometer before and after lens removal and with a transpalpebral tonometer before, during (0 h, 1 h, and 2 h), and after lens wear. CCT increased after wearing L1 (8.10 ± 4.21 µm; p < 0.01) and L2 (9.17 ± 4.41 µm; p < 0.01). After L1 removal, the ICA parameters decreased significantly (p < 0.05). With L2 removal, nasal and temporal SC area and length were reduced (p < 0.05). An increased IOP with transpalpebral tonometry was observed at 2 h of wearing L1 (2.55 ± 2.04 mmHg; p < 0.01) and L2 (2.53 ± 2.22 mmHg; p < 0.01), as well as an increased IOP with Perkins applanation tonometry after wearing L1 (0.43 ± 1.07 mmHg; p = 0.02). In the short term, SL resulted in a slight increase in IOP in addition to small changes in ICA and SC parameters, although it did not seem to be clinically relevant in healthy subjects.

Case Series: Transient Corneal Subepithelial Macrocysts with Scleral Contact Lens Wear

Scleral lens wear is indicated in cases of corneal irregularity and ocular surface disease to improve vision and ocular surface condition. The purpose of this case series is to discuss transitory corneal subepithelial macrocysts associated with scleral lens wear in various conditions such as dry eye, post-radial keratotomy, and post-superficial keratectomy. Such diseased or damaged corneas have weakened epithelial attachments which can lead to macrocyst formation. Three cases documented with spectral-domain anterior segment optical coherence tomography highlight the clinical presentation of corneal subepithelial macrocysts. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Corneal oedema during reverse piggyback scleral lens wear.

One clinical approach to address poor front surface wettability during scleral lens wear is the use of a "reverse piggyback" system (a soft contact lens applied to the anterior surface of a scleral lens). The aim of this study was to compare the magnitude of corneal oedema induced following short-term reverse piggyback scleral lens wear and standard scleral lens wear. Ten young (mean age 22 ± 6 years) healthy participants with normal corneas were recruited. On separate days, central corneal thickness and fluid reservoir thickness were measured using optical coherence tomography before and after 90 min of standard scleral lens wear (Kerectasia Alignment Tangent Torus diagnostic lenses, hexafocon A, Dk 100 × 10-11 (cm2 /s)(ml O2 /ml × mmHg), Capricornia Contact Lenses, capcl.com.au) and reverse piggyback scleral lens wear (the same scleral lens with a Dailies Total 1®, delefilcon A, Dk 140 × 10-11 (cm2 /s)(ml O2 /ml × mmHg), Alcon, alcon.com, applied to the anterior scleral lens surface). After correcting for small variations in the initial central fluid reservoir thickness, central corneal oedema was similar between the reverse piggyback (2.32 ± 1.15%) and standard scleral lens conditions (2.02 ± 0.76%; p = 0.45). Following 90 min of lens wear, the highly oxygen-permeable reverse piggyback system did not induce a clinically or statistically greater magnitude of central corneal oedema compared with standard scleral lens wear in young adults with healthy corneas. This approach may be suitable to address poor front surface scleral lens wettability or to correct residual refractive error during diagnostic scleral lens fitting.

Nonpolar Lipids Contribute to Midday Fogging During Scleral Lens Wear.

To determine correlations between lipids in the fluid reservoir (FR) and the severity of midday fogging (MDF) in scleral lens (SL) wear. SL neophytes were recruited to wear custom SL for 4 days, examined after 8 hours on days 1 and 4. Lens vault and MDF were quantified from anterior segment optical coherence tomography (AS-OCT), and the FR was collected and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Relative abundance of lipids was compared to MDF scores using nonparametric correlation testing (Spearman rank). Ocular surface and SL fitting characteristics (lens vault, fitting curves) were likewise compared to MDF. Thirteen participants (26 eyes, 69% female, 28 ± 9 years old) were included in this study. MDF severity after 8 hours of SL wear was 33 ± 29 units on day 1 and 28 ± 24 units on day 4 (r=.94; P < 0.01). Twelve samples were analyzed using LC-MS/MS, and a total of 170 distinct lipid species were detected. The lipid classes with greatest correlation to MDF were the wax esters (r=.73, P=0.01), cholesteryl esters (r=.59; P=0.049), and triacylglycerols (r=.64, P=0.03). Polar lipids were observed abundantly in all samples. None of the measured ocular surface or fitting outcomes were correlated to MDF. Nonpolar lipids were the greatest contributors to MDF among these normal participants. Polar lipids may be due to cellular debris, although they do not appear contributory to MDF.

Survey-Based Estimation of Corneal Complications Associated with Scleral Lens Wear.

The benefits of scleral lens (SL) wear have been described in cross-sectional and retrospective studies; however, the frequency of complications associated with SL wear has not, to the best of our knowledge, been determined. From a survey of SL practitioners, we estimated the period prevalence over 1 year of corneal complications that required SL wearers to discontinue lens wear. In a sample of 72,605 wearers, SL wear was discontinued for the following complications: corneal edema, 1.2%; corneal neovascularization, 0.53%; microbial keratitis, 0.45%; and limbal stem cell deficiency, 0.20%. This study design allowed for calculation of period prevalence of these complications rather than complication incidence rates. Information presented in this report may be useful in clinical decision-making and for future study design.