Scleral Lenses Research Articles

Instrumented Contact Lens to Detect Gaze Movements Independently of Eye Blinks.

To test on humans an eye tracker based on the use of a contact lens with active infrared sources and to evaluate whether this system can track the eye behind the eyelid. The system is made up of a scleral contact lens embedding two vertical cavity self-emitting lasers (VCSELs) remotely driven by eyewear comprised of electronics and cameras. Tests on humans were carried out on five subjects to assess performance and to determine whether the VCSEL spot could be detected behind the eyelid. The lens was worn and used without difficulty. The device allowed accurate tracking of the eye (0.83° ± 0.59°), and the VCSELs can be detected behind closed eyelids. These results confirm those previously obtained in terms of tracking and demonstrate that the device can be used safely to monitor eye movements even when the eyelids are closed. The VCSELs could be useful for a variety of applications to reduce data missed due to blinks, particularly with regard to interactive systems, fundamental studies on closed eye movements, or finding ways to improve clinical diagnostic precision for disorders of consciousness.

Size Matters: A Comparative Study on Midday Fogging and Lens Settling in Patients With Keratoconus Wearing Mini-Scleral Lenses With Two Different Diameters

Purpose: The objective of this study was to compare the changes in postlens fluid optical density, timing and quantity of lens settling, and the clinical performance between two different mini-scleral lenses. Methods: Seventeen eyes of 10 patients with keratoconus were fitted with a 15-mm mini-scleral lens (AirKone Scleral Lenses; Laboratoire LCS, Normandy, France), and 15 eyes of 10 patients with keratoconus were fitted with 16.5-mm mini-scleral lenses (Misa Lenses; Microlens Contactlens Technology, Arnhem, The Netherlands). The lens fit was evaluated with biomicroscopy and anterior segment optical coherence tomography (AS-OCT). At 0, 2, and 4 hrs, corneal clearances were measured with AS-OCT, and optical density measurements were made by Scheimpflug tomography. High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were assessed at each time point. At the end of the 4th hour, participants' comfort, visual quality, and general satisfaction were evaluated with a 5-point Likert scale and 100-mm Visual Analog Scale (VAS) scale. Results: The mean age (24.4 ± 5.4 vs. 21.7 ± 4.5, P = 0.145) and best spectacle-corrected HCVA (0.36 ± 0.15 vs. 0.35 ± 0.20, P = 0.984) were similar in both groups. The mean Snellen HCVA significantly improved with dispensing both mini-scleral lenses and remained stable at 4 hrs in both groups. In comparison, CS significantly decreased at 4 hrs in both groups (P = 0.02). Both groups' optical density significantly increased over time (P = 0.003). In the 15-mm mini-scleral lens group, the settling amount was 62.2 ± 11.9 μm (62.6%) and 99.5 ± 14.2 μm (100%) at 2 and 4 hrs, respectively; in the 16.5-mm mini-scleral lens group, it was 46.4 ± 22.3 μm (56.4%) and 82.1 ± 37.3 μm (100%) at 2 and 4 hrs, respectively. More than 50% of settling occurred in the first 2 hrs in both groups. No significant difference was observed between the two groups with regard to visual acuity, CS, optical density, and total settling amount at 4 hrs (P > 0.05). Patient in the 15-mm mini-scleral lens group scored higher in comfort (4.65 ± 0.7 vs. 3.60 ± 0.9), visual quality (4.76 ± 0.4 vs. 3.73 ± 0.7), and overall satisfaction (95.7 ± 6.0 vs. 65.3 ± 20.3) (P < 0.0001). Conclusion: Patients reported a heightened level of contentment with the smaller-diameter lens; however, it is crucial to emphasize that both diameter scleral lenses showcase comparable clinical efficacy, midday fogging, and settling.

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.

Case Report: Front surface eccentricity of scleral lens: Its impact on visual quality in eyes with higher-order aberrations induced by refractive surgery

Purpose To report the impact of front surface eccentricity (FSE) of scleral lenses (SCLs) on the visual performance of eyes exhibiting refractive surgery-induced higher-order aberrations (HOAs) Method A female teenager presented to the clinic with blurring of vision and dependency on spectacles even after undergoing Small Incision Lenticule Extraction (SMILE) in both eyes (BE). Her presenting uncorrected high contrast distance visual acuity (HCDVA) was 20/60 in the right eye (RE) and 20/40 in the left eye (LE). On examination, the cornea showed a ring-shaped area of ablation with faint scarring and a well-apposed lenticule-extraction site. Subjective refraction improved the HCDVA to 20/20p in RE and 20/25 in LE but the patient was not happy with the quality of vision. Ocular aberrometry revealed an increase in total HOAs as the underlying cause of unsatisfactory vision. Result A contact lens trial was recommended for BE to enhance visual quality. Rigid corneal lenses (RCLs) were tried, but the patient was intolerant to them. Large diameter SCLs of different FSEs (0, 0.6, and 0.8) were tried to reduce these aberrations. SCL with FSE 0 yielded the most favourable visual outcome, which was confirmed subjectively on ocular aberrometry. Conclusion With this case report, we hypothesize that the eccentricity of SCL can be selected according to the asphericity (at 6 mm) of the posterior corneal surface. This case also re-emphasizes the impact of SCL with varying FSEs on reducing HOAs and enhancing visual quality in eyes where conventional RCLs yield suboptimal results.

EVALUATING THE LEARNING CURVE OF A NOVICE OPTOMETRY STUDENT IN SCLERAL LENS FITTING: A PROSPECTIVE QUANTITATIVE STUDY USING DELIBERATE PRACTICE AND CUMULATIVE SUMMATION (LC-CUSUM)

Background and Objective: To evaluate the learning curve of a novice optometry student in scleral lens fitting through deliberate practice and to objectively quantify the learning process using the LearningCurve-Cumulative Summation (LC-CUSUM) test, ensuring accurate and unbiased results. Method: The complexity of scleral contact lens fittings was assessed by categorizing subjects into regular and irregular cornea groups. A student enrolled in the Master of Optometry program conducted the fittings using a dedicated scleral lens record form (rubrics) designed to quantify the lens management approach. Prior to performing fittings independently, the student received four weeks of training from a contact lens expert, who also served as her guide for the study. This training period and the subsequent fittings were structured based on the principles of deliberate practice, with the student performing repeated diagnostic trials. A maximum of three diagnostic trials were performed for each subject to achieve the optimal fit. After each trial, the student completed a self-efficacy scale questionnaire to assess her perceived diffi-culty and clinical judgement skills, recording “FIRST trial scores” following the initial trial and ‘LAST trial scores’ after achieving the optimal fit. The guide consistently provided verbal feedback after each case throughout the fitting process as part of the deliberate practice methodology to enhance the student’s understanding of the fitting procedure while keeping the scores confidential to ensure unbiased self-as-sessment. Following the complete supervision of the fitting procedure, the guide evaluated the student’s clinical skills using a specially designed observation scale questionnaire, referred to as the ‘GUIDE scores.’ A seven-point Likert scale was used to rate the judgement for both the self-efficacy scale and observation scale questionnaire. The student’s LAST trial scores were subsequently compared with the GUIDE scores. Results: A total of 80 scleral lens fittings were evaluated. The Intraclass Correlation Coefficient (ICC) demonstrated excellent agreement between student-reported self-efficacy scores and guide-reported observation scores. The difference in self-efficacy scores between the initial and final lens fittings was statistically significant (p &lt; 0.05), as determined by the Wilcoxon signed-rank test. The Learning Curve-Cumulative Summation (LC-CUSUM) chart revealed that learning stabilized after 26 fittings, marking a consolidation phase where minimal further improvement was observed beyond this point, and additional practice primarily helped to maintain proficiency. The average number of trials required per eye was higher in patients with irregular corneas than those with regular corneas. Conclusion: This study evaluated the learning curve of a novice optometry student in scleral lens fitting through deliberate practice, utilizing the LC-CUSUM test to quantify progress and assess skill acquisition objectively. Proficiency was achieved after 26 fittings, with additional trials needed for irregular corneas, underscoring the influence of patient characteristics on learning. These findings emphasize the importance of structured training, personalized feedback, and self-assessment in developing clinical competence. The insights contribute to advancing education and research in contact lens science by providing practical guid-ance for designing effective programs focused on planning, teaching, and learning about scleral lens fittings.

Piggyback Scleral Contact Lens to Enhance Cosmesis and Comfort in Uniocular Stevens-Johnson Syndrome.

Stevens-Johnson syndrome often results in a significant reduction in vision, dryness, and photophobia based on severity. Scleral lenses are well-considered visual interventions that enhance vision and comfort, resulting in an increased quality of life for patients. This case report describes the enhancement of comfort, cosmesis, and reduction of photophobia using a piggyback system (scleral contact lenses over a prosthetic contact lens), whereas the other modalities were unsatisfactory.

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.

Keratoconus.

Keratoconus is a progressive eye disorder primarily affecting individuals in adolescence and early adulthood. The ectatic changes in the cornea cause thinning and cone-like steepening leading to irregular astigmatism and reduced vision. Keratoconus is a complex disorder with a multifaceted aetiology and pathogenesis, including genetic, environmental, biomechanical and cellular factors. Environmental factors, such as eye rubbing, UV light exposure and contact lens wearing, are associated with disease progression. On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy. Clinically, keratoconus is diagnosed through clinical examination and corneal imaging. Advanced imaging platforms have improved the detection of keratoconus, facilitating early diagnosis and monitoring of disease progression. Treatment strategies for keratoconus are tailored to disease severity and progression. In early stages, vision correction with glasses or soft contact lenses may suffice. As the condition advances, rigid gas-permeable contact lenses or scleral lenses are prescribed. Corneal cross-linking has emerged as a pivotal treatment aimed at halting the progression of corneal ectasia. In patients with keratoconus with scarring or contact lens intolerance, surgical interventions are performed.

Impact of Scleral Lenses on Visual Acuity and Ocular Aberrations in Corneal Ectasia: A Comprehensive Review.

Corneal ectasias, including keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia, poses significant visual rehabilitation challenges due to the resultant irregular astigmatism, myopia, and higher-order aberrations (HOAs). These conditions often resist traditional corrective methods, necessitating advanced optical solutions. Scleral lenses (SLs) have emerged as a primary non-surgical option for managing these complex corneal irregularities. SLs form a smooth optical interface by forming a tear-filled chamber between the lens and the cornea, effectively mitigating HOAs and improving both high-contrast and low-contrast visual acuity (VA). This review evaluates the efficacy of SLs in enhancing VA and reducing aberrations in patients with corneal ectasia. It also explores the technological advancements in SLs, such as profilometry and wavefront-guided systems, which enable more precise and customized lens fittings by accurately mapping the eye's surface and addressing specific visual aberrations. The current body of evidence demonstrates that custom SLs significantly improve visual outcomes across various ectatic conditions, offering superior performance compared to conventional correction methods. However, challenges such as the complexity of fitting and the need for precise alignment remain. Ongoing innovations in SL technology and customization are likely to further enhance their clinical utility, solidifying their role as an indispensable tool in the management of corneal ectasias.

Acquired Ankyloblepharon Correction Using Ocular Surface and Tarsal Mucous Membrane Grafting in Cicatrizing Ocular Surface Diseases

Purpose: To report the long-term surgical outcomes of acquired ankyloblepharon correction using mucous membrane graft. Methods: Five eyes of 4 patients (median age, 19 years) with acquired ankyloblepharon were managed using eyelid splitting and mucous membrane graft anchored to the recti muscles on the bulbar surface in the respective quadrant and onto the bare tarsal surface. Outcome measures include a change in the palpebral fissure width, ability to fit scleral contact lenses, visual acuity, and cosmesis. Results: The underlying etiologies of ankyloblepharon were chronic Stevens-Johnson syndrome (n = 3), and chemical injury (n = 2). All 5 eyes had conjunctival shortening, and 3 had severe dry eyes (median Schirmer 4.5 mm). Four eyes had limbal stem cell deficiency. The median horizontal palpebral fissure width improved to 22 mm from 8 mm. This single-staged surgical technique allowed for fornix formation and prosthetic replacement of the ocular surface ecosystem lens fitting in all 5 eyes. Median logMAR visual acuity improved from 2.1 to 0.7 following ankyloblepharon release, prosthetic replacement of the ocular surface ecosystem lens fitting in 4 eyes, and keratoprosthesis in 1 eye. Repeat mucous membrane graft for recurrent symblepharon in 1 quadrant was required in 2 eyes where complete 360 degrees bulbar and tarsal conjunctiva loss were present preoperatively. At the median follow-up period of 27 months, all patients reported better cosmesis and had no symblepharon recurrence following repeat surgery in 2 eyes and single surgery in 3 eyes. The donor site healed well without any complications. No mitomycin C or symblepharon ring was used. Conclusion: Ocular surface and adnexal reconstruction using bulbar and tarsal mucous membrane grafts help visually rehabilitate patients with acquired ankyloblepharon secondary to cicatrizing ocular surface disorders.

Change in Tear Layer Thickness under Scleral Contact Lenses in Keratoconus Patients and Normal Cornea Volunteers

Objective: To quantify rate of post-lens tear thickness change under scleral contact lenses in keratoconus patients and normal cornea volunteers. Materials and Methods: We conducted a prospective observational study where semi-scleral lenses were fitted to 20 eyes (5 subjects, 10 eyes in each group). After insertion, post-lens tear thickness was measured at 0, 30 minutes and every hour up to 6 hours using Anterior Segment OCT. To analyze post-lens tear thickness and its rate of change at each time point, both within and between groups, a linear mixed model was used. Results: The initial mean post-lens tear thickness (µm) was 742 ± 50 and 440 ± 50 in keratoconus and normal cornea group, respectively. The mean rate of change (µm/hr) was highest in the first 30 minutes in both groups (80.8 ± 8.7, 132.2 ± 8.8 in keratoconus and normal cornea group). Following the first four hours in keratoconus and the first hour in normal cornea group, the reduction rate in post-lens tear thickness exhibited no statistically significant difference from the rate of change observed during the 5-6 hour period. The mean percentage of total change over 6 hours after lens insertion was higher in normal cornea compared to keratoconus group (36.6% vs 22.5%). Conclusion: The reduction in post-lens tear thickness follows a nonlinear pattern. The mean rate of change was highest after insertion and remained stable after four hours in keratoconus and one hour in normal cornea group. The percent change over the 6-hour period was greater in normal cornea group.

Oxygen permeability and gas permeable contact lens materials

In this article, we will examine the importance of oxygen permeability (Dk) in gas permeable contact lens materials, and the significance of high Dk in scleral and ortho-k lens designs.

Does the palpebral morphology influence the tear meniscus height between Caucasian and Asian eyes?

The central lower TMH is used as a clinical measure of tear volume in the assessment of contact lens candidates and patients with dry eyes. Ethnic differences in eyelid morphology may influence the measurement of the TMH. Furthermore, with the advent of larger contact lenses, such as scleral lenses, it would be of clinical value to assess the TMH centrally and peripherally. The purpose of this study was to evaluate and compare the TMH at different positions along the palpebral margin between Caucasian and Asian eyes. This prospective study evaluated the lower TMH in five positions (central, temporal and nasal limbus and temporal and nasal periphery) of the right eye using the Keratograph 5M (Oculus) instrument in Caucasian and Asian participants between 10 am and 12 pm. The TMH at each position was taken three times and averaged and analyzed using a 5 × 2 repeated-measures analysis of variance. Central TMH did not differ significantly (F = 0.02, p=0.88) in Caucasians (n = 20, aged 24.45 [2.30] years, TMH 0.320 [0.052] mm) and Asians (n = 20, aged 22.25 [3.43] years, TMH 0.325 [0.048] mm). A difference was noted with respect to TMH positions along the lid margin (F = 64.17, p<0.001), independent of ethnicity (F = 2.15, p=0.15). A post hoc analysis revealed a significantly higher TMH temporally when compared with centrally or nasally (p<0.001). This study demonstrated the similarity of the central TMH and the differences in the peripheral TMH within Caucasian and Asian eyes. This may be clinically relevant when using the Tear Film & Ocular Surface Society Dry Eye Workshop II diagnostic algorithm for dry eyes and when fitting scleral contact lenses. Future studies need to consider that ethnic differences may exist for certain tests in order to personalize the care and management of each patient.

Scleral lens surface crazing in an eye with giant papillary conjunctivitis and keratoconus: Outcome of lens surface polishing

We present a case of scleral lens surface crazing in a patient with keratoconus (KC) and chronic giant papillary conjunctivitis (GPC). A 45-year-old Asian male with known keratoconus (KC) and allergic eye disease in both eyes, who is an experienced scleral lens user, presented with a 3-month history of lens intolerance in the right eye. On examination, the right eye scleral lens showed extensive lens surface crazing with poor surface wettability. The upper tarsal conjunctiva showed conjunctival hypertrophy – active GPC. After allergy treatment and symptomatic improvement, the scleral lens was refitted after intensive cleaning and polishing with aluminum oxide. The lens surface showed significant improvement and good fitting characteristics, and the patient resumed lens wear. At 6 months of follow-up, the patient was asymptomatic, and the ocular condition was stable.

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).

Anpassung von Skleral-Kontaktlinsen bei Terrien‘s marginaler Hornhautdegeneration

Purpose. This case report describes the possible visual rehabilitation with scleral lenses of a patient with Terrien’s marginal degeneration with different degrees of progression between the right and left eye. Material and Methods. Scleral contact lenses were fitted with the help of corneal tomography and by observing and assessing the fit of measuring lenses. A slit lamp with a corresponding camera helped to modify the diagnostic lenses. Results. In this case, the fitting of scleral contact lenses resulted in an improvement in distance vision in both the right and left eye. Near vision could not be evaluated at the time of writing. Conclusion. Scleral contact lenses can be a good alternative to glasses for complex corneas to improve visual performance. It is recommended to use a slit lamp with a camera to make it easier to discuss scleral contact lenses modifications with the manufacturer of the lenses. Keywords: TERRIEN’S MARGINAL CORNEAL DEGENERATION, PELLUCIDE MARGINAL CORNEAL DEGENERATION, SCLERAL LENSES

Scleral contact lens treatment for corneal contact lens intolerance after keratoplasty

Purpose. The aim of this case report is to describe the treatment of a 47-year-old man with scleral lenses due to intolerance of corneal contact lenses after keratoplasty as a result of keratoconus. Material and Methods. The initial examinations included visual acuity tests, slit lamp examination and detailed corneal topography using Keratograph 5M and Pentacam AXL Wave. Based on these measurements, scleral lenses were fitted to improve visual acuity and wearing comfort of the contact lenses. Results. The fitted scleral lenses were subjectively and objectively tolerated without complications the whole day. The visual acuity improved from 0.05 to 1.0 in the right eye and from 0.80p to 1.00 in the left eye. Conclusion. The fitting of scleral lenses offers many advantages over corneal lenses in cases of corneal ectasia or dry eyes. In this case, scleral lenses provided significantly improved visual results and comfort. Regular follow-up examinations were scheduled to ensure safe and complication-free vision with the contact lenses.

Globe Subluxation in the Specialty Contact Lens Practice

Purpose. This report documented the occurrence of globe subluxation (GSL) during the insertion of a scleral contact lens (SL) and described the management of two keratoconus patients, in need of a gas permeable contact lens prescription and experiencing GSL. Furthermore, an anatomical explanation for the occurrence of spontaneous GSL is attempted. Material and Methods. Two separate case reports of GSL were evaluated and described. In case 1, the patient experienced GSL secondary to insertion of a trial SL and in case 2 the patient had experienced multiple GSLs secondary to Grave’s disease. Different management strategies were taken to help to provide functional vision for these patients. In case 1, the patient was fitted with a smaller corneal gas permeable lens to minimize lid manipulation needed to insert a lens and provide effective correction. In case 2, the patient’s existing Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) SL was designed to increase vertical lens steepness to tighten the lens fit and minimize the chance of losing the lens during wear. Results. With the help of the individually fitted contact lenses, it was possible to achieve visual rehabilitation in accordance with the patient’s specific needs. Conclusion. SL are fitted with increasing frequency and tend to require excessive lid manipulation, which may lead to GSL. This small case series demonstrated different lens design and selection maybe utilized to minimize the occurrence of GSL. The superior septum orbitale is perforated several times across the width of the upper lid by the aponeurosis of the levator. This structural arrangement weakens the superior septum orbitale and, postulated here, predisposes the eye to GSL by a herniation primarily of the superior septum orbitale.

Two-year follow-up of a post-traumatic choroidal rupture with a lens luxation patient: a case report

Background: A choroidal rupture is a break in the choroid, Bruch membrane, and retinal pigment epithelium (RPE) that occurs most commonly as a result of blunt ocular trauma. It may be a secondary effect of direct or indirect trauma. This case illustrates an indirect post-traumatic choroidal rupture with lens luxation. Three months following the incident, the patient presented with impaired vision. The posterior segment was found to have a luxated lens during the objective examination of the eye. The funduscopy revealed a white, curvilinear, crescent-shaped streak that was concentric to the optic nerve. Case description: A 45-year-old male from East Java visited the ophthalmology outpatient clinic with a chief complaint of blurred vision in the left eye for three months, followed by pain in the left eye. On examination, the visual acuity was a one-meter counting finger. The lens was luxated to the posterior. The funduscopy examination revealed a curvilinear crescent-shaped streak. Vitrectomy and lensectomy were implemented. After four months of aphakia, the patient underwent a scleral fixation intraocular lens (IOL) implantation. The visual acuity was satisfactory, and no complications were observed during the two-year follow-up. Conclusion: We reported a post-traumatic choroidal rupture and a lens luxation with an optimal outcome after a two-year follow-up.