Steps to fitting scleral lenses

Professor in optometry at the Indiana University’s School of Optometry, Dr Jason Jedlicka, highlighted the importance of fitting scleral lenses efficiently and shared a series of steps for optometrists to follow during his session at the Hospital and Specialty Optometrists Conference (HSOC).  

During the event, which was held at the University of Warwick last year (November 4–5), Jedlicka explained that through his lecture he was “specifically trying to help practitioners be more efficient with the fitting process.”

“Scleral lenses can be challenging for anyone to fit efficiently,” he reassured, adding that this was particularly true for “a health system in a country like the UK, where follow-up care is challenging to get patients back – we really want to focus on how do we get to an acceptable end point as quickly as possible with the least number of visits for a patient.”

The professor assured that “when a scleral lens is fitted properly, a patient will often say ‘I can’t tell that it’s on my eye’,” adding: “They can be just as comfortable as in a soft lens, but it requires getting the lenses to fit properly.”

During the session, Jedlicka emphasised the importance of all optometrists understanding the application of scleral lenses, even if they decide not to fit them. He said this was important so that practitioners can talk to patients and refer them to other practitioners for scleral lenses when required.

“Even if you are not going to fit them, you should understand their application,” he told OT, adding: “We all have a lot of things that our patients benefit from, surgical procedures or treatments for example, that we don’t do individually, but we know they would benefit from so we refer them. Being able to understand when a scleral lens is appropriate, even if you are not going to fit it, is helpful.” 

In practice

Jedlicka shared that fitting scleral lenses can be rewarding in practice. He said that there was no doubt that there are practitioners out there who could be fitting scleral lenses if they felt that they better understood “the hows and whys.”

While the professor acknowledged that scleral lenses have “always been a bit associated to the corneal and the disease eyes,” there is no reason why they cannot be worn by normal eyes to correct refractive error, he said.

Identifying and talking delegates through his four steps for fitting scleral lenses efficiently, Jedlicka highlighted that overall it is about, “making sure that we are really properly assessing the patient’s eye that we are going to fit; [that we] take the time to understand that eye carefully; [that we] take the time to understand the lens that we are fitting and know it well; and then, beyond that, we are talking about looking at the fit aspects.”

He summarised that, “all of which is to say that we are going to try our best to get it one and done.”

“That’s maybe not realistic, but the least number of visits and reorders the better,” he added.