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

1. Initial Evaluation: An eye care professional will review medical history and conduct a thorough eye exam.
2. Corneal Topography: Mapping the cornea’s surface to identify irregularities.
3. Lens Selection: Based on the topography results, a scleral lens is selected.
4. Trial Lens Fitting: A trial scleral lens is placed on the eye and filled with a saline solution.
5. Evaluation: The lens fit, comfort, and visual acuity are assessed. Adjustments are made if necessary.
6. 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.