Things To Consider When Fitting Young Patients With Scleral Lenses

Scleral lenses can produce amazing results in pediatric patients. They are often used for ocular surface protection or in cases of trauma-induced severe irregular astigmatism, which makes fitting a corneal GP lens difficult. Given the enormous therapeutic benefits, it is important for doctors to master the skill of fitting very young patients with scleral lenses, according to Dr Christine W Sindt from the Department of Ophthalmology and Visual Sciences at the University of Iowa.

In an article published in the April issue of Contact Lens Spectrum, Sindt shares her experience with infant patients and discusses lens size, changes in fit, application and assessment.

When it comes to answering the question of size, Sindt noted that it depends on why fitting is required. If the aim is to provide ocular surface protection, the best choice is a lens that covers as much of the globe as possible. The largest lens diameter will be determined by the size of the horizontal aperture. According to Sindt, most children older than six months can be fitted with an 18+mm lens.

Most eye growth (90%) takes place in the first year but during that time there can be quite sudden bursts of change in fit. While corneal GP lenses will begin to pop out as the eye grows, scleral lenses become tight and quickly lead to neovascularisation. This means that infants with scleral lenses need to undergo examinations on a monthly basis.

With regards to application, the removal process does not differ for infants or adults. With children, however, the easiest way to put the lens in the eye is by having the patient lying face down because of the fluid reservoir. Sindt noted in conclusion that a portable cobalt filter provides the easiest method of lens assessment.