Pediatric Scleral Lenses
21-Year Retrospective Review
The care and treatment of vision problems in childhood is particularly challenging, especially when conventional visual aids are not sufficient. Scleral lenses are a promising alternative that have been increasingly used in recent decades to treat diseases of the ocular surface, irregular corneal shapes, and complex refractive errors. A 21-year retrospective study by Carrasquillo et al.1 highlights the long-term effects and benefits of scleral lenses in pediatric care.
Patient profile and study design
Between 1998 and 2019, a total of 209 eyes of children and adolescents were analyzed to examine the efficacy and tolerability of scleral lenses. The study included 108 male and 101 female patients, with an average age of 10.6 years at the start of treatment. Patients were divided into two main groups: 147 eyes (70 %) had diseases of the ocular surface such as keratoconus, aniridia or corneal dystrophy, while 62 eyes (30 %) had irregular corneal shapes or high refractive errors that required correction.
Long-term results
A key finding of the study was the high level of patient acceptance of the scleral lenses. Of the 209 eyes treated, 147 (70 %) continued to use the lenses over a long period of time. The average duration of use was 8.2 years. Only 16 eyes (8 %) discontinued scleral lens use, with handling difficulties and discomfort cited as the main reasons.
Visual improvement
A key objective of the study was to measure the effects of scleral lenses on visual acuity. The mean LogMAR visual acuity improved significantly from 0.93 to 0.43 while the lenses were in use. This corresponds to a significant improvement in vision, which provided patients with a higher quality of life. Even at the last measurement, there was a sustained improvement, with the LogMAR value remaining at 0.4.
Lens parameters and fitting over time
The analysis showed that the average lens diameter changed slightly over the years. It originally measured 17.7 mm but increased to 18.2 mm. The lenses were customized based on the development of the eye and the specific requirements of the patients. The larger lens size refuted the earlier assumption that smaller lenses were more suitable for children. Rather, larger scleral lenses proved to be more stable and comfortable.
Factors for successful application
The study highlighted the crucial role of parents and caregivers, especially in younger patients. Consistent care and support significantly facilitated adjustment and long-term use. In addition, regular follow-up by medical specialists proved to be essential to ensure the best possible lens fitting and management.
Strong evidence for the safety and efficacy
The results of this long-term study underscore that scleral lenses are an effective and sustainable option for therapeutic and visual rehabilitation in children. They can enable significant improvements in vision and lifestyle, particularly for patients with complex visual problems. However, the successful application of scleral lenses in pediatrics requires comprehensive care, individual adjustment, and the active participation of parents and ophthalmologists.
The study provides moreover strong evidence for the safety and efficacy of scleral lenses in pediatric patients and suggests that they should be considered as an early treatment option. Continued development of lens technology and fitting techniques may optimize their use in the future to ensure the best possible care for affected children.
Summerized:
This large sample size (209 eyes) and long-term retrospective study (21 years) on pediatric scleral lens outcomes supports scleral lenses as an efficacious treatment option for the pediatric patient population. The mean age at the time of treatment initiation was 10.6 years and at the time of the last evaluation recorded was 14.7 years. 70% of the patients continued to wear scleral lenses at the time of the review, with an average wear time of eight years. The mean starting diameter of 17mm increased to a mean ending diameter of 18.2 at the time of last evaluation in our cohort, demonstrating that large diameter options do not seem to be a deterrent for successful lens wear in this patient population. There was statistically significant visual rehabilitation in both ocular surface disease and irregular cornea/refractive conditions. Only 8% of eyes discontinued lens wear in our cohort, and of these, challenges with application and removal were the predominant reason for discontinuation.
DOI https://doi.org/10.2147/OPTO.S494398
1 Karen G Carrasquillo, Kellen Riccobono, Jennifer Liao, Yueming Shi, Bita Asghari, Daniel Brocks, Estelle Crowley, Buddika Peiris , Email kcarrasquillo@bostonsight.org
