An online survey of 352 respondents reveals scleral lens wear improved best-corrected visual acuity (BCVA) for patients with corneal irregularity and ocular surface disease (OSD) over their prior correction, but not for those fit for refractive error, according to a new study, conducted by the Scleral lenses in Current Ophthalmic Practice Evaluation (SCOPE) group,1

Of the respondents, 257 fits were for corneal irregularity such as keratoconus, pellucid marginal degeneration and post-surgical astigmatism, 23 were for patients with for ocular surface disease and 14 were for simple refractive error. Scleral lenses gave irregular cornea patients improved BCVA, from 0.39 ± 0.37 before lens wear to 0.09 ± 0.18 after lens wear, while OSD patients improved from 0.35 ± 0.38 to 0.09 ± 0.27 in the right eye and 0.27 ± 0.28 to 0.06 ± 0.27 in the left eye.1 But sclerals conferred no notable benefit for uncomplicated refractive error correction.

“This large online survey sheds light on many aspects of scleral lens use for regular and irregular corneas as well as ocular surface disease,” says Joseph P. Shovlin, OD, of Scranton, PA. “As one would expect, the SCOPE study confirms significant improvement in acuity for patients who are fit with scleral lenses for irregular corneal surfaces and ocular surface disease.”

The same group of researchers also used online surveys to look at scleral lens wear vs. gas permeable lenses (GP) for patients with keratoconus. They found sclerals provide better vision and comfort and less lens loss than GP lens wear—but with a catch. Those wearing scleral lenses reported more difficulty with lens insertion and removal, and that they spend more time handling the lenses on a daily basis compared with their GP-wearing counterparts. Despite this, both groups reported overall satisfaction with ease of lens use.2

“Because scleral lens wearers with keratoconus seem to have more complaints with lens care and handling and they spend more time handling their lenses on a daily basis, clinicians should carefully explain the pluses and minuses to the potential wearer when employing scleral lens technology,” says Dr. Shovlin.

Finally, SCOPE results revealed patients with keratoconus who wear GPs experience more severe dry eye compared with those wearing scleral lenses. The researchers used an online survey that asked patients to self-report a diagnosis of keratoconus and then complete the Ocular Surface Disease Index (OSDI) to document dry eye symptoms.3 Of the 422 participants, 76 wore scleral lenses in both eyes and 75 wore GPs. The overall OSDI severity score was significantly higher in GP wearers compared with scleral lens wearers, even after controlling for age of diagnosis or years living with keratoconus.3 “This is likely due to the reservoir effect in scleral lens features,” says Dr. Shovlin.

In addition, GP wearers were more likely to report feelings of grittiness and discomfort in windy and low humidity environments.3    

All three studies were presented this week during the ARVO annual meeting taking place in Honolulu, Hawaii.

1. Harthan JS, Nau CB, Schornack M, et al. Visual outcomes with scleral lenses: a SCOPE study. ARVO 2018. Abstract 1760-B0075.
2. Nau CB, Schornack M, Harthan JS, et al. COPE study: Experience of keratoconus patients wearing RGP or Scleral lenses. ARVO 2018. Abstract 1778-B0093.
3. Shorter E, Harthan JS, Nau A, et al. SCOPE study: Comparing severity of dry eye symptoms in keratoconus patients using corneal gas permeable lenses versus scleral lenses. ARVO 2018. Abstract 1775-B0090.