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Suh, Lee, Lee, Park, Lee, and Lee: Fitting the Miniscleral Contact Lens in Patients with Corneal Abnormalities
Original Article

J Korean Ophthalmol Soc 2016;57(11):1699-1705.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1699

Fitting the Miniscleral Contact Lens in Patients with Corneal Abnormalities

Su Youn Suh, MD1, Jong Heon Lee, MD1, Seung Uk Lee, MD, PhD2, Young Kee Park, MD, PhD3, Jong Soo Lee, MD, PhD1, Ji Eun Lee, MD, P

1Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

2Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea

3YK Eye Clinic, Seoul, Korea

4Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2590, Fax: 82-55-360-2161 E-mail: jiel75@hanmail.net

Received 14 July 2016       Revised 9 August 2016       Accepted 17 October 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical results of fitting the miniscleral contact lens (MSD; Happy Vision Corp., Anyang, Korea) in patients with corneal abnormalities.

Methods

Thirty-eight patients (56 eyes) fitted with MSD lenses were recruited for this study. Clinical indication, visual acuity, degree of comfort, mean wearing time, parameters of the finally prescribed lenses, number of fittings with trial lenses, success rate with the first prescribed lens, and adverse events were evaluated.

Results

Forty-two (75%) of 56 eyes were enrolled in this study due to keratoconus. Other conditions included Stevens-Johnson syndrome (6 eyes, 11%), high postkeratoplasty astigmatism (3 eyes, 5%), corneal scarring (3 eyes, 5%), and ectasia after laser in situ keratomileusis (LASIK; 2 eyes, 4%). The mean log MAR visual acuity improved from 1.01 ± 0.64 to 0.13 ± 0.19 after wearing lenses (p = 0.0001). In 53 eyes (94.6%), patients reported the miniscleral contact lenses to be comfortable, and the mean daily wear time was 12.9 ± 2.5 hours. The mean sagittal depth of finally prescribed lenses was 4.67 ± 0.37 mm (3.7–5.4). An average of 3.3 ± 1.5 (1–7) trials were needed for the trial fitting, and the average number of re-prescriptions to achieve the optimal fitting was 1.5 ± 0.48 (1–3). One patient discontinued the lenses after 3 months due to discomfort.

Conclusions

Miniscleral contact lenses are a good alternative for patients with corneal abnormalities and result in both successful visual outcome and comfort.

Keywords: Corneal abnormalities, Miniscleral contact lens, Scleral lens fitting

References

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Figure 1.
Corneal clearance after fitting of miniscleral contact lens. Optical coherence tomography section was used to define precorneal tear reservoir thickness profile compared with lens thickness. The central thickness of miniscleral lenses ranges from 250 μm to 350 μm.
jkos-57-1699f1.tif
Figure 2.
Three different landing zone designs. (A) Too steep curve, (B) proper curve, and (C) too flat curve. Larger blood vessels may be impeded by a steep curve (A) and too flat curve (C) makes conjunctival vessels at the lens edge broken, which can cause lens awareness and discomfort compared to the proper curve (B).
jkos-57-1699f2.tif
Figure 3.
Change in best-corrected visual acuity between corneal rigid gas permeable contact lenses or glasses and miniscleral contact lenses. Points lying above the solid 45° line correspond to eyes with improved vision with miniscleral contact lenses.
jkos-57-1699f3.tif
Figure 4.
Distribution of self-reported assessment of miniscleral contact lens comfort. The Mini Scleral Design (MSD) lenses were very comfortable in 28 eyes (50.5%), comfortable in 25 eyes (44.1%) and mildly irritating in 3 eyes (5.4%) of all 56 eyes.
jkos-57-1699f4.tif
Table 1.
Prefitted demographic data of the patients
Parameters Data
Age (years) 31.5 ± 8.5 (19∼55)
Gender (male:female) 27 (71%):11 (29%)
Length of follow-up (months) 8.4 ± 4.1 (6∼10)
Refractive error  
 Myopia (D) –7.64 ± 6.10 (−28.25∼−1.50)
 Astigmatism (D) 4.48 ± 3.98 (0.25∼16.0)
Topographic indices  
 Sim-Kmin (mm) 7.14 ± 0.91 (5.26∼9.17)
 Sim-Kmax (mm) 6.53 ± 0.94 (4.68∼8.27)

Values are presented as mean ± SD (range) unless otherwise indicated. D = diopter.

Table 2.
Causes of the corneal abnormality
Condition Number of eyes (%)
Keratoconus 42 (75)
Stevens-Johnson syndrome 6 (11)
Irregular astigmatism after corneal transplant 3 (5)
Corneal scarring 3 (5)
Ectasia after LASIK 2 (4)

LASIK = laser in situ keratomileusis.

Table 3.
Parameters of final lenses
Parameters Data
Sagittal depth (mm) 4.67 ± 0.37 (3.7–5.4)
Midperipheral zone design (eyes)  
 Standard 48 (85.7)
 Double increased 6 (10.7)
 Increased 1 (1.8)
 Decreased 1 (1.8)
Landing zone design (eyes)  
 Standard 16 (28.6)
 One-step flat 25 (44.6)
 Two-step flat 15 (26.8)
Power (D) –5.99 ± 3.82

Values are presented as mean ± SD or n (%) unless otherwise indicated. D = diopter.

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