Our Quest for the Perfect Scleral Lens
It started about seven years ago in late 2007. We had developed a passion for helping restore sight to patients who had lost quality of vision to various eye diseases and surgeries. We were developing a large base of international clientele who would come in on Monday and leave on Friday. It was imperative that we could work within that time frame.
Because of the proximity of so many excellent lens manufacturers, we could get what we needed fairly quickly. It was relatively easy to customize the lenses to specific patients’ needs. But despite all that, the traditional approach of using trial lenses had too many shortcomings. Patients’ needs were just too diverse and often unpredictable.
Visante OCT Scanner
Our facility needed some sort of scanning device that would provide accurate images out into the scleral region of the eye, unlike corneal topography, which just measured the cornea. One day, I was talking to Jan Svochak of Truform Optics, and I mentioned a specific type of scanner and asked if he could make lenses from the scanned data. He said he had been wondering the same thing, and so we ordered in a Visante OCT and dove right in, measuring and sending the data to Truform.
The Road to Perfection is Paved with Obstacles
My initial hope was that this new approach would make mini-scleral lens fitting easier and quicker, but unfortunately, that was not the case. Eyes were too asymmetrical, and there would often be residual astigmatism.
The Complexity Increases
Additional scans were needed to do bitoric lenses. We quickly learned that bitoric designs were limited. We then moved on to quadrant specific designs and still found fitting issues with that approach. During this process we came to the realization that even larger lenses would be required. This meant even more scans, and additional points of adjustment for the lenses. After lots of hard work, we now had reached the point where we could produce extremely well fitting lenses with little or no focal compression. They also proved to be non-rotational. This seemed to be everything we needed, or was it? While patients appreciated the improvements they were getting with their vision, there were a number of them who were still experiencing the effects of residual higher order aberrations or irregular astigmatism, even with the best scleral lenses.
