Clinical Report: Enhancing Tear Exchange in Scleral Lenses via Peripheral Modifications

Overview

Scleral lenses typically exhibit minimal tear exchange, which can contribute to complications such as fluid reservoir debris and corneal hypoxia. A recent study demonstrated that incorporating peripheral channels into scleral lens landing zones significantly enhances short-term tear exchange compared to toric or notched designs.

Background

Scleral lenses differ from soft and corneal rigid lenses by having minimal tear exchange beneath the lens, which may exacerbate complications like midday fogging and corneal hypoxic stress during extended wear. Modifications to the lens landing zone, including fenestrations, notches, or channels, have been proposed to improve tear dynamics. Quantifying tear exchange with these modifications can guide customization to reduce adverse effects. The study evaluated tear exchange in healthy adults wearing scleral lenses with three different peripheral designs.

Data Highlights

Key Findings

• Scleral lenses with peripheral channel modifications showed significantly greater tear exchange than toric or notched designs.
• Peripheral channel lenses increased tear ingress particularly in the corneal periphery, likely by reducing contact between the lens landing zone and ocular surface.
• Notched lens designs demonstrated reduced tear exchange compared to both channel and toric lenses.
• Fluorescent intensity measurements confirmed that tear exchange varies with lens design, time, and corneal location.
• Enhanced tear exchange with channel designs may help mitigate complications associated with stagnant post-lens fluid reservoirs.

Clinical Implications

Incorporating peripheral channels into scleral lens landing zones can improve tear exchange, potentially reducing complications such as midday fogging and hypoxic stress. Clinicians should consider these modifications when fitting scleral lenses, especially for patients experiencing lens-related debris or discomfort. This evidence supports further innovation in scleral lens customization to optimize ocular surface health.

Conclusion

Peripheral channel modifications to scleral lenses quantitatively enhance short-term tear exchange compared to toric and notched designs. These findings provide a foundation for improving scleral lens performance and patient outcomes through targeted lens design adjustments.

References

1. Iqbal et al. 2025 -- Peripheral scleral lens modifications and tear exchange
2. Walker et al. 2016 -- Complications and fitting challenges associated with scleral contact lenses: A review
3. Alexander et al. 2024 -- The effect of landing zone toricity on scleral lens fitting characteristics and optics