Scleral Risks?

[Julie1]

Hi everyone!

I hope you all had a great New Year's!!

I just had a few questions about the Sclerals. I am not ready just yet to make the jump to go the Scleral route, but I was wondering about any medical risks? Other than time, travel, money, and the discomfort of wearing the Sclerals, are there any medical problems that have resulted from long-term Scleral wear?

I think I remember reading about some microbacterial growth somewhere, but I cannot remember where... Were those people with microbacterial growth successfully treated?

Thanks, Julie

[DrG]

If you go to the PubMed website and type Rosenthal P AND scleral into the search term, you will find about 6 studies, several of which will provide the information you are looking for.

[Julie1]

Thanks, Dr. G!

Am I correct in understanding that the risks might be some bacterial infection (that may be also associated with normal contact lens wear) and that the bacterial infection cleared up for all the patients. I would think that the risk of bacterial infection would be greater for patients with severe dry eye as there are few tears to wash away bacteria.

-Julie

[DrG]

Am I correct in understanding that the risks might be some bacterial infection (that may be also associated with normal contact lens wear) and that the bacterial infection cleared up for all the patients. I would think that the risk of bacterial infection would be greater for patients with severe dry eye as there are few tears to wash away bacteria.

I'm sorry that I don't have the full text of those articles at hand, but I have read at least one of them in full.

The combination of a persistent epithelial defect and a scleral lens appears to be particulary troublesome from the standpoint of infection, especially if it is kept on the eye on a continuous basis. I believe that the incidence was 4/22 and 4/17 cases of ulcerative keratitis, which is very high and exceeds by a wide margin the normal incidence of infection with extended wear contact lenses. Diseased and compromised corneas are indeed much more susceptible to infection. It is important to note that these patients all had non-healing epithelial defects, i.e. abrasions, which served as portals of entry for bacteria. The sealed chamber of the lens can apparently act as a culture medium.

I also remember that the problem was addressed by the addition of antibiotic drops to the lens prior to insertion. Again, I believe that these patients were wearing their scleral lenses continuously.