Name of the Procedure:
Common Name(s): Scleral Contact Lens Fitting
Technical/Medical Term: Contact Lens, Scleral, Gas Permeable (HCPCS Code V2531)
Summary
Overview: Scleral contact lenses are large, rigid gas-permeable lenses that rest on the sclera (the white part of the eye) and vault over the cornea. They are designed to provide a smooth optical surface for people with irregular corneas, promoting better vision and comfort.
Purpose
Medical Conditions: Keratoconus, severe dry eye syndrome, corneal ectasia, post-surgical corneas, and individuals with irregular corneas due to injury or degenerative conditions.
Goals/Outcomes: To improve vision, protect the cornea, and enhance comfort for patients with specific ocular conditions that regular contact lenses cannot adequately address.
Indications
- Moderate to severe dry eye syndrome
- Keratoconus
- Corneal scarring or irregularities
- Post-refractive surgery complications (e.g., LASIK, RK)
- Severe astigmatism
Preparation
Pre-Procedure Instructions:
- No specific fasting required.
- Patients should remove any contact lenses several hours prior to the fitting.
- Bring an up-to-date prescription and any relevant medical records.
Diagnostic Tests:
- Comprehensive eye examination
- Corneal topography or tomography to map the shape of the cornea
- Tear film assessment for dry eye evaluation
Procedure Description
- Initial Evaluation: An eye care professional will review medical history and conduct a thorough eye exam.
- Corneal Topography: Mapping the cornea’s surface to identify irregularities.
- Lens Selection: Based on the topography results, a scleral lens is selected.
- Trial Lens Fitting: A trial scleral lens is placed on the eye and filled with a saline solution.
- Evaluation: The lens fit, comfort, and visual acuity are assessed. Adjustments are made if necessary.
- Prescription: Once the best-fitting lens is found, a prescription is written for a custom scleral lens.
Tools/Equipment:
- Diagnostic scleral lenses
- Slit-lamp biomicroscope
- Corneal topographer
Anesthesia/Sedation: Not typically required, but numbing drops may be used for patient comfort during the fitting.
Duration
Time Taken: Approximately 1 to 2 hours for the initial fitting.
Setting
Location: Outpatient clinic or optometrist/ophthalmologist office.
Personnel
- Optometrist or ophthalmologist
- Optometric technicians or assistants
Risks and Complications
Common Risks:
- Mild discomfort during the initial adaptation period
- Temporary redness or irritation
Rare Risks:
- Corneal infection if lenses are not properly cleaned
- Hypoxia (reduced oxygen to the cornea) if lenses are worn excessively
Complication Management: Immediate removal of lens, cleaning, and consultation with eye care professional if complications arise.
Benefits
Expected Benefits:
- Improved visual acuity for irregular corneas
- Enhanced comfort for severe dry eye patients
- Protection of compromised corneal surfaces
Realization Time: Benefits are typically noticed immediately but can improve further after initial adaptation.
Recovery
Post-Procedure Care:
- Regular cleaning and proper handling of the lenses
- Gradual increase in wearing time, as tolerated
- Follow-up appointments for lens adjustments
Recovery Time: Few days to few weeks for full adaptation; varies by individual.
Alternatives
Other Options:
- Glasses (may not provide adequate vision for certain conditions)
- Other types of contact lenses (soft lenses, hybrid lenses)
- Corneal transplant (for severe cases)
Pros/Cons:
- Glasses: Non-invasive but may not sufficiently correct vision.
- Other Contact Lenses: Less invasive but may not fit as well.
- Corneal Transplant: Potential for vision improvement in severe cases, but involves surgical risks.
Patient Experience
During Procedure:
- Mild to moderate discomfort as eyes adapt to the scleral lenses
- Initial feeling of a foreign object in the eye
Post-Procedure:
- Adaptation period where comfort gradually improves
- Minimal pain; manageable with over-the-counter pain relief if needed
- Regular follow-up and adjustments enhance overall experience and effectiveness.