Boris Severinsky is Chief of Specialty Lens Service at the Emory University School of Medicine. His experience includes design and fitting of specialty contact lens for keratoconus, after corneal surgery and management of ocular surface disease. He has published a number of articles in peer-reviewed optometry and contact lens journals and lectures nationally and internationally on various contact lens and corneal disease topics. Dr. Severinsky is a Fellow of the American Academy of Optometry, the British Contact Lens Association, and the Scleral Lens Educational Society.
From Vision to Ocular Surface Rehabilitation: A Paradigm Shift in Scleral Lens Prescribing
To evaluate the penetration rate of scleral contact lenses into the contemporary cornea and ocular surface disease practice and determine what conditions have the best success rate with scleral lens therapy
Retrospective chart review of 183 consecutive patients fitted with scleral contact lenses at the Ophthalmology Department of Emory University from April 2018 to March 2019. We evaluated the fitting indications, time required for the ocular surface stabilization and the vision rehabilitation success
This study included 281 eyes of 183 patients. Among them, 94 eyes (33.5 %) were fitted for the management of an ocular surface disease. Main surface conditions were Keratoconjunctivitis Sicca (KS) of autoimmune etiology in 38 eyes, Ocular Graft-Versus-Host Disease (GVHD) in 18, Neurotrophic Keratitis (NK) in 15 , Ocular Cicatricial Pemphigoid (OCP) in 11 and Stevens-Johnson syndrome (SJS) in 6 eyes. The rest of the patients were fitted for irregular cornea vision rehabilitation. Of the eyes examined, 88% of eyes fitted for ocular surface-related indications responded well to therapy and continued scleral lens wear. The highest success rates were recorded in GVHD (86%), OCP (98%) and NK (84%) groups. The mean visual acuity among surface disease patients improved from 20/80 to 20/30 when corrected with a scleral lens (range: 20/400 to 20/20).
This study shows higher, than previously reported in the literature, rate of therapeutic scleral lens use for ocular surface disease management. Referral for scleral lens fitting is not limited to ophthalmology, and other medical professions need to have an increased awareness of their therapeutic benefits. This allows timely referrals and may save sight in many cases.