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Purpose: Although the frequency in which practitioners are fitting scleral
contact lenses is increasing, the recommendation for proper tear layer depth
(thickness) varies amongst experts. The main goal of this paper is to clinically
verify the effect of varying tear layer depths on induced corneal edema during
lens wear.
Methods: Ten subjects with healthy eyes were fitted with scleral lenses on their
right eye. Each of them was fit with two different lenses: one with an apical
clearance of 200 μm and another with an apical clearance of 600 μm. They wore
the lenses for 8 hours on two different days, with at least a one week wash-out
period. Lenses were applied at 8 a.m. on each of the testing days. Pachymetry
measurements were taken one day prior to lens wear at 4 p.m., on the day of
wear prior to lens application, and after removal of the lenses at 4 p.m.
Measurements were collected using both the Pentacam® HR Corneal
Tomographer, as well as the Visante Anterior Segment Optical Coherence
Tomographer (OCT). The apical clearance was measured using the
Visante OCT at two intervals during the test day: immediately after application of
the lens and immediately prior to the removal of the lens.
Results: In this study, there was found to be no significant difference in corneal
edematous response during lens wear between the two test groups. The study
shows that the eyes with the lenses have a statistically significantly thicker
cornea compared to the non-lens-wearing eye after wearing either lens for 8
hours, lying within clinically and physiologically acceptable limits.
Conclusion: Our clinical results do not correlate with current theoretical
calculations, which predict a greater amount of corneal swelling with increasing
tear layer thickness. It has to be evaluated if the effect on corneal edema
changes with longer wearing periods, larger samples or other influences.
Key words: scleral (contact) lens, corneal edema, pachymetry, tear layer
thickness, vaulting, apical clearance