Rethinking Tear Exchange in Sclerals - Scorecard - MDSpire
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Rethinking Tear Exchange in Sclerals
Discover how innovative channel modifications in scleral lenses can significantly enhance tear exchange and mitigate common complications, according to recent findings by Dr. Melissa Barnett.
Clinical Scorecard: Rethinking Tear Exchange in Sclerals
At a Glance
Category
Detail
Condition
Scleral lens wear and associated tear exchange dynamics
Key Mechanisms
Minimal tear exchange under scleral lenses; modifications such as fenestrations, notches, or channels can enhance tear exchange
Target Population
Adults with normal corneas fitted with scleral lenses
Care Setting
Optometry and contact lens specialty clinics
Key Highlights
Scleral lenses exhibit minimal tear exchange compared to soft and corneal rigid lenses, contributing to complications like post-lens debris and corneal hypoxic stress.
Peripheral channel modifications in scleral lenses significantly increase tear exchange, especially in the corneal periphery, compared to toric landing zones or notches.
Enhanced tear exchange via channel designs may reduce complications and guide future scleral lens customization.
Guideline-Based Recommendations
Diagnosis
Assess corneal health and suitability for scleral lens wear in adults with normal corneas.
Management
Consider scleral lens modifications such as peripheral channels to enhance tear exchange and reduce complications like midday fogging and hypoxic stress.
Use toric landing zones to reduce lens rotation and maintain fit stability.
Monitoring & Follow-up
Monitor for post-lens fluid reservoir debris and midday fogging during extended scleral lens wear.
Evaluate tear exchange dynamics using fluorescein profilometry or equivalent methods when available.
Risks
Extended scleral lens wear with minimal tear exchange may increase risk of corneal hypoxic stress and fluid reservoir debris accumulation.
Patient & Prescribing Data
Nine healthy adults with normal corneas, mean age 34 years
Peripheral channel modifications in scleral lenses increased tear ingress and fluorescein intensity, indicating improved tear exchange compared to toric and notch designs.
Clinical Best Practices
Fit scleral lenses with a 150 µm toric landing zone to reduce rotation and optimize fit.
Incorporate peripheral channel modifications to enhance tear exchange and potentially reduce complications.
Use noninvasive profilometry and fluorescein to quantitatively assess tear exchange during lens wear.
Reapply sodium fluorescein after lens settling to evaluate tear ingress and exchange dynamics.
