Enhancing Scleral Lens Fit With Advanced Imaging

This prospective, single-center clinical trial aims to refine the process of fitting scleral lenses by utilizing advanced imaging technologies to enhance the precision and predictability of lens adaptations for individuals with complex corneal conditions. Conducted at Centro Fernández in Madrid, Spain, the study focuses on patients who have historically struggled with standard contact lens solutions due to conditions such as keratoconus, post-surgical corneal irregularities, and severe dry eye syndrome.

Study Objectives:

The primary objective of the study is to determine if detailed sagittal height measurements obtained from the Oculus Pentacam CSP can predict the necessary adjustments required for an optimal scleral lens fit. The secondary objective is to assess whether the use of these precise measurements can reduce the number of adjustments and follow-up visits typically required, thus improving overall patient satisfaction and clinical efficiency.

Methods and Procedures:

Participants will be enrolled based on specific inclusion criteria, including a history of intolerance or incompatibility with other forms of contact lenses. The study will include the following steps:

Initial Evaluation: Comprehensive ocular surface assessment using the Oculus Pentacam, which provides detailed corneal and scleral topography.

Lens Fitting: Custom scleral lenses will be fitted based on the Pentacam CSP measurements, with a focus on achieving a central vault of approximately 300 microns over the cornea.

Follow-Up Assessments: Participants will return for follow-up visits to assess the fit of the lenses, comfort, and visual outcomes. Adjustments to the lenses will be made based on these assessments.

Imaging and Technology:

The Oculus Pentacam CSP is a pivotal tool in this study, offering high-resolution imaging that captures detailed topographical data of both the cornea and sclera. This data is crucial for customizing each scleral lens to the unique contours of the patient's ocular surface, potentially reducing the iterative nature of traditional scleral lens fittings.

Expected Outcomes:

The study is expected to produce several key outcomes:

Validation of Predictive Models: Establishing reliable predictive models correlating sagittal height measurements with lens fitting parameters.

Clinical Efficiency: Reduction in the total number of fitting sessions required, as well as decreased chair time during each visit.

Patient Satisfaction: Improvement in patient comfort and visual acuity, leading to higher satisfaction rates.

Impact on Clinical Practice:

By demonstrating the effectiveness of integrating advanced imaging technologies into the scleral lens fitting process, this study aims to influence current practices significantly. It is anticipated that the results will provide evidence-based guidelines that can be adopted widely, leading to more predictable and efficient scleral lens fittings across various clinical settings.

Inclusion criteria

• Age 18 years and older. Diagnosed with keratoconus, post-corneal transplant irregularities, or severe dry eye disease, which are indicated for scleral lens usage.

Previous intolerance or inability to use other types of contact lenses such as soft or rigid gas-permeable lenses.

Willing and able to comply with scheduled visits, treatment plan, and other study procedures.

Adequate ocular health suitable for contact lens wear, except for conditions being treated in the study.

Ability to give informed consent.

Exclusion criteria

• Under 18 years of age. Active ocular infection or inflammation. History of herpetic keratitis. Severe allergies or contraindications to any component of the scleral lenses or imaging dyes used in the study.

Any condition which, in the opinion of the investigator, may interfere with safe participation in the study or adherence to study procedures.

Participation in another simultaneous clinical trial that might confound the results of the current study.

Pregnant or breastfeeding women.