Scleral Contact Lenses

Joanne has Neurofibromatosis type 2 (NF2) which resulted in two acoustic neuromas. One was removed while Joanne still lives with the other. As a result, Joanne lost her hearing and was left with facial palsy. Maintaining eye health is extremely important for Joanne, she shared her experience of scleral contact lenses with us in November 2019.

Back tracking a few months to the dim and distant memories of summer, I found myself with an eye infection that wasn’t clearing, I decided to go to Eye Casualty at my local hospital and that revealed far more than I imagined it would. The eye infection was caused by a very small ulcer which would be treated with antibiotic drops (LOTS and LOTS of!), but the underlying cause was a dangerously thin cornea almost on the verge of perforating. I was rushed in for an emergency tarsorrhaphy (stitching the eye lids together) and advised this would need to stay for a number of weeks to let the cornea heal itself. The cause of the cornea problems was in fact due to lack of eye closure from the lower lids and it was suggested I should have surgery to lift the lower eyelids.

That weekend, barely able to see, I searched the internet for alternatives. I had heard of scleral lenses before but hadn’t really noted what they did. After much reading they seemed to be the answer I was looking for, they protect the precious cornea layer through a reservoir of saline whilst keeping the eye moist preventing severe dry eyes, which was the overall root of my problem. They are bigger than standard contacts which is why they can protect the cornea better. They are Rigid Gas Permeable (RGP) lenses which means your eyes can breathe better.

At the next clinic check-up, I took all of my information in about scleral contact lenses and after a couple more clinic appointments they supported my decision to go ahead with them.

The waiting times with our lovely NHS for referral for the lenses was LONG so I decided to do my own research and find a qualified optometrist who specialises in sclerals and go that route instead. I had many pictures and measurements taken of my eye to confirm the prescription I needed. Due to other eye complications my brain only uses one eye to see, so I only needed the one lens for my ‘good’ eye.

Fast forward a few weeks after the tarsorrhaphy was removed and my eye was relatively healed, I had a trial with a lens. That half hour trial went really well and the lens after initially putting it in settled to be really comfortable as if I wasn’t wearing a lens at all, it felt natural!

After the trial it took a couple of weeks for my custom lens to be made and I had a fitting with it. It felt comfortable from the offset, like I should have done this a long time ago!!

I’m now just over a week into having it and already I know it was the right decision for me.

I can see much better with the lens, visual acuity has increased, and I know it is protecting my eye better, it feels clean and moist. I’m also able to use fewer drops daily (previously every hour or more). At night I still use ointment.

So for me it feels like I did the right thing. I’m getting confidence up wearing it and practising getting the lens in and out (which can be tricky). I’ve joined a Facebook group to get some tips and never realised sclerals were suited to so many different eye conditions. However I also realise that sometimes things aren’t straightforward with them and it can take a while to get the right types and the right fitting, which is why you need someone who specialises in them. I think I’ve been very lucky that my new optometrist measured everything perfectly, so it fitted first time.

Sclerals, don’t dismiss them, they might just be the game changer for me.

Expert comment

Scleral lenses are an excellent part of the armamentarium in protecting an eye. They are also something ophthalmologists overlook as we tend to concentrate more on surgical options when required to intervene to protect the cornea. They can be used where surgery hasn’t managed to achieve eye closure fully, or where further surgery can’t reliably be performed without reducing the visual field dramatically.

Scleral lenses are especially useful in eyes with reduced sensation. They protect the cornea from abrasions and ulcers which would otherwise be very slow to heal due to lack of corneal sensation.

They protect the eye as well as improve vision as they allow for a layer of tears to cover the cornea. Lubricants can be instilled as required although the requirement for lubrication is usually reduced.

Scleral lenses are large and take some time to learn to insert or remove them. Of course, not easily done if the aperture has been reduced surgically with a tarsorraphy!

Professor Ahmed Sadiq (Consultant Ophthalmic and Oculoplastic Surgeon), 2019

Glossary

Acoustic neuroma – A benign brain tumour that grows on the nerve used for hearing and balance.

Armamentarium – the medicines, equipment, and techniques available to a medical practitioner.

Cornea – the transparent front part of the eye that covers the iris, pupil and anterior chamber.

Tarsorrhaphy – a surgical procedure in which the eyelids are partially sewn together to narrow the eyelid opening.

Visual acuity – the sharpness or clarity of vision