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Scleral gas permeable lenses have come of age
Contact Lens and Anterior Eye 39 (2016) 247–248
Contents lists available at ScienceDirect
Contact Lens and Anterior Eye journal homepage: www.elsevier.com/locate/clae
Editorial
Scleral gas permeable lenses have come of age
The very first scleral contact lenses applied to the human eye in the late 1880’s by the visionary practitioners Friedrich and Albert Müller, Adolf Eugen Fick, Carl Zeiss, Eugène Kalt and August Müller (no relation to the Müller brothers) were ahead of their time but did not work very well [1–3]. The concept was brilliant but the technology simply was not available to provide the materials necessary to ensure clinical success and nor the equipment to machine the complex curvatures that shapes todays scleral lenses. A century later, materials, originally gas impermeable, had improved to the point where it appeared that the wear of scleral gas permeable (SGP) lenses became a viable proposition [4]. Pioneers in the now reborn scleral lens field, Donald Ezekiel, Ken Pullum and Perry Rosenthal reported promising results [5–8]. Add a few years and the development of the current computer driven lathes, now able to cut a combination of complex surfaces and we have truly arrived at a device that could be the first choice for irregular corneal surfaces, severe dry eye disease and a multitude of ocular pathologies including keratoconus and post-surgical ectasias. Today we even, on occasion, dispense SGPs to normal and healthy eyes! The SGP is now readily available to practitioners, who developed an interest in this field but it is no longer a device limited to those practitioners with their own laboratory to manufacture these lenses. Albeit a small market, the SGP is nonetheless the fastest growing one in the contact lens field [9].
It will not be a surprise to learn that the SGP is now due to have its own meeting – the International Forum for Scleral Lens Research (IFSLR) scheduled for December 5th 2016 by the Texas Eye Research and Technology Center, Houston, Texas, University of Houston College of Optometry. It should also be noted that scleral contact lenses now have their own learned society; The Scleral Lens Education Society (SLS), which is a proud sponsor of IFLSR and supports the science and art of prescribing SGP lenses. Membership is free of charge; additionally, practitioners who have demonstrated advanced knowledge of SGP lenses have the opportunity to become a Fellow of SLS. The SLS welcomes the international SGP community to join its growing membership. For more information, please visit https://www.sclerallens.org. The SGP is a phenomenal device and a wonderful addition to the contact lens practitioner’s armament in meeting the needs of patients. However, like all contact lens modalities, the SGP comes with its own set of often unique challenges, such as midday fogging, conjunctival prolapse, handling and potential edema issues to name a few [9–11]. Furthermore, there is no consensus on the ideal size or vault of a SGP. There also needs to be a consensus on how lens specification should be expressed, either in base curve or sagittal depth measurements, or both? In other words, there is a great need for evidence based information and this is the intention of IFSLR.
35 30 25 20 15 10 5 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Fig. 1. The number of papers with the keywords ‘scleral lenses’ that have appeared in CLAE in the last 20 years according to a search on Science Direct. Please note that the 2016 figures are a prediction based on the number of papers up to the mid-year point in 2016.
http://dx.doi.org/10.1016/j.clae.2016.06.007 1367-0484/ã 2016 Published by Elsevier Ltd on behalf of British Contact Lens Association.
248
Editorial / Contact Lens & Anterior Eye 39 (2016) 247–248
A look through the amount of peer reviewed literature over the last few years it is quite interesting to see how many papers appear on SGP. In CLAE the number of papers on this topic is shown in Fig. 1. It seems to show a slow overall trend towards a steady increase in number of publications, enough perhaps to allow us to say we reached the critical mass to be considered a subspecialty of its own. But it also highlights the need for robust research – the rapid expansion of the SGP on the market place is not matched by a similar expansion in research. There appears to be a plateau of papers around ten years ago but the last five years seem to show a revived interest. Peer review quality manuscripts in the field of SGP have a natural home in CLAE with several Editorial Board members being providers of SGP care and contributors to the literature concerning this field. To advance this field, we need both clinical and basic research to provide the evidence we need for guidance in managing our patients. This is not to say that the SGP is an unsafe product. In fact, SGP lenses have a great safety record [6,12]. Our goal is to optimize the SGP lens experience for our patients and simplify the fitting and availability of SGP lenses in all parts of the world to competent eye care practitioners. We invite you to support the advancement of evidence based SGP knowledge by submitting manuscripts to CLAE, joining SLS and attending IFSLR on December 5, 2016 in Houston, TX. References [1] T.J. Bowden, Development of scleral contact lenses, Contact Lenses: The Story, first ed., Bower House Publications, Gravesend, UK, 2009, pp. 40–164. [2] A.E. Fick, A contact-lens (translated by May CH), Arch Ophthalmol 17 (1888) 215–216. [3] R.M. Pearson, Kalt, keratoconus, and the contact lens, Optom Vis Sci 66 (9) (1989) 643–646.
[4] J.P.G. Bergmanson, D.F. Ezekiel, E. van der Worp, Scleral contact lenses and hypoxia. Theory versus Practice. Guest Editorial, Contact Lens Anterior Eye 38 (2015) 145–147. [5] D. Ezekiel, Gas permeable haptic lenses, J Br Contact Lens Assoc 6 (1983) 158– 161. [6] K.W. Pullum, R.J. Buckley, A study of 530 patients referred for RGP scleral contact lens assessment, Cornea 16 (1997) 612–622. [7] K.W. Pullum, M.A. Whiting, R.J. Buckley, Scleral contact lenses: the expanding role, Cornea 24 (2005) 269–277. [8] O.D. Schein, P. Rosenthal, C. Ducharme, A gas-permeable scleral contact lens for visual rehabilitation, Am J Ophthalmol 109 (3) (1990 15) 318–322. [9] J.J. Nichols, Contact lenses 2015, Contact Lens Spectrum (2016 January) 18–24. [10] M. Walker, J.P.G. Bergmanson, W.L. Miller, Marshak, L.A. Johnson, Complications and fitting challenges associated with scleral contact lenses: a review, Contact Lens Anterior Eye 39 (2016) 88–96. [11] L. Michaud, E. van der Worp, D. Brazeau, R. Warde, C.J. Giasson, Predicting estimates of oxygen transmissibility for scleral lenses, Contact Lens Anterior Eye 35 (2012) 266–271. [12] M. Pecego, M. Barnett, M.J. Mannis, B. Durbin-Johnson, Jupiter Scleral Lenses – The UC Davis Eye Center Experience, Eye Contact Lens 38 (3) (2012) 179–182.
Jan P.G. Bergmanson OD, PhD, PhD hc, DSc, FCOptom, FAAO, FSLS (Chair of the organizing committee of the International Forum for Scleral Lens Research)a Melissa Barnett OD, FAAO, FSLS (President, Scleral Lens Education Society (SLS))b Shehzad A. Naroo BSc(Hons), MSc, PhD, FIACLE, FAAO, FBCLA, FEAOO, FCOptom (Editor-in-Chief, Contact Lens and Anterior Eye)c a Texas Eye Research and Technology Center, University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77204-2020, United States b Department of Ophthalmology, University of California, Davis Eye Center, 77 Cadillac Drive, Suite 101, Sacramento, CA 95825, United States c
Ophthalmic Research Group, School of Life and Health Sciences, Aston University, B4 7ET, UK
Contents lists available at ScienceDirect
Contact Lens and Anterior Eye journal homepage: www.elsevier.com/locate/clae
Editorial
Scleral gas permeable lenses have come of age
The very first scleral contact lenses applied to the human eye in the late 1880’s by the visionary practitioners Friedrich and Albert Müller, Adolf Eugen Fick, Carl Zeiss, Eugène Kalt and August Müller (no relation to the Müller brothers) were ahead of their time but did not work very well [1–3]. The concept was brilliant but the technology simply was not available to provide the materials necessary to ensure clinical success and nor the equipment to machine the complex curvatures that shapes todays scleral lenses. A century later, materials, originally gas impermeable, had improved to the point where it appeared that the wear of scleral gas permeable (SGP) lenses became a viable proposition [4]. Pioneers in the now reborn scleral lens field, Donald Ezekiel, Ken Pullum and Perry Rosenthal reported promising results [5–8]. Add a few years and the development of the current computer driven lathes, now able to cut a combination of complex surfaces and we have truly arrived at a device that could be the first choice for irregular corneal surfaces, severe dry eye disease and a multitude of ocular pathologies including keratoconus and post-surgical ectasias. Today we even, on occasion, dispense SGPs to normal and healthy eyes! The SGP is now readily available to practitioners, who developed an interest in this field but it is no longer a device limited to those practitioners with their own laboratory to manufacture these lenses. Albeit a small market, the SGP is nonetheless the fastest growing one in the contact lens field [9].
It will not be a surprise to learn that the SGP is now due to have its own meeting – the International Forum for Scleral Lens Research (IFSLR) scheduled for December 5th 2016 by the Texas Eye Research and Technology Center, Houston, Texas, University of Houston College of Optometry. It should also be noted that scleral contact lenses now have their own learned society; The Scleral Lens Education Society (SLS), which is a proud sponsor of IFLSR and supports the science and art of prescribing SGP lenses. Membership is free of charge; additionally, practitioners who have demonstrated advanced knowledge of SGP lenses have the opportunity to become a Fellow of SLS. The SLS welcomes the international SGP community to join its growing membership. For more information, please visit https://www.sclerallens.org. The SGP is a phenomenal device and a wonderful addition to the contact lens practitioner’s armament in meeting the needs of patients. However, like all contact lens modalities, the SGP comes with its own set of often unique challenges, such as midday fogging, conjunctival prolapse, handling and potential edema issues to name a few [9–11]. Furthermore, there is no consensus on the ideal size or vault of a SGP. There also needs to be a consensus on how lens specification should be expressed, either in base curve or sagittal depth measurements, or both? In other words, there is a great need for evidence based information and this is the intention of IFSLR.
35 30 25 20 15 10 5 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Fig. 1. The number of papers with the keywords ‘scleral lenses’ that have appeared in CLAE in the last 20 years according to a search on Science Direct. Please note that the 2016 figures are a prediction based on the number of papers up to the mid-year point in 2016.
http://dx.doi.org/10.1016/j.clae.2016.06.007 1367-0484/ã 2016 Published by Elsevier Ltd on behalf of British Contact Lens Association.
248
Editorial / Contact Lens & Anterior Eye 39 (2016) 247–248
A look through the amount of peer reviewed literature over the last few years it is quite interesting to see how many papers appear on SGP. In CLAE the number of papers on this topic is shown in Fig. 1. It seems to show a slow overall trend towards a steady increase in number of publications, enough perhaps to allow us to say we reached the critical mass to be considered a subspecialty of its own. But it also highlights the need for robust research – the rapid expansion of the SGP on the market place is not matched by a similar expansion in research. There appears to be a plateau of papers around ten years ago but the last five years seem to show a revived interest. Peer review quality manuscripts in the field of SGP have a natural home in CLAE with several Editorial Board members being providers of SGP care and contributors to the literature concerning this field. To advance this field, we need both clinical and basic research to provide the evidence we need for guidance in managing our patients. This is not to say that the SGP is an unsafe product. In fact, SGP lenses have a great safety record [6,12]. Our goal is to optimize the SGP lens experience for our patients and simplify the fitting and availability of SGP lenses in all parts of the world to competent eye care practitioners. We invite you to support the advancement of evidence based SGP knowledge by submitting manuscripts to CLAE, joining SLS and attending IFSLR on December 5, 2016 in Houston, TX. References [1] T.J. Bowden, Development of scleral contact lenses, Contact Lenses: The Story, first ed., Bower House Publications, Gravesend, UK, 2009, pp. 40–164. [2] A.E. Fick, A contact-lens (translated by May CH), Arch Ophthalmol 17 (1888) 215–216. [3] R.M. Pearson, Kalt, keratoconus, and the contact lens, Optom Vis Sci 66 (9) (1989) 643–646.
[4] J.P.G. Bergmanson, D.F. Ezekiel, E. van der Worp, Scleral contact lenses and hypoxia. Theory versus Practice. Guest Editorial, Contact Lens Anterior Eye 38 (2015) 145–147. [5] D. Ezekiel, Gas permeable haptic lenses, J Br Contact Lens Assoc 6 (1983) 158– 161. [6] K.W. Pullum, R.J. Buckley, A study of 530 patients referred for RGP scleral contact lens assessment, Cornea 16 (1997) 612–622. [7] K.W. Pullum, M.A. Whiting, R.J. Buckley, Scleral contact lenses: the expanding role, Cornea 24 (2005) 269–277. [8] O.D. Schein, P. Rosenthal, C. Ducharme, A gas-permeable scleral contact lens for visual rehabilitation, Am J Ophthalmol 109 (3) (1990 15) 318–322. [9] J.J. Nichols, Contact lenses 2015, Contact Lens Spectrum (2016 January) 18–24. [10] M. Walker, J.P.G. Bergmanson, W.L. Miller, Marshak, L.A. Johnson, Complications and fitting challenges associated with scleral contact lenses: a review, Contact Lens Anterior Eye 39 (2016) 88–96. [11] L. Michaud, E. van der Worp, D. Brazeau, R. Warde, C.J. Giasson, Predicting estimates of oxygen transmissibility for scleral lenses, Contact Lens Anterior Eye 35 (2012) 266–271. [12] M. Pecego, M. Barnett, M.J. Mannis, B. Durbin-Johnson, Jupiter Scleral Lenses – The UC Davis Eye Center Experience, Eye Contact Lens 38 (3) (2012) 179–182.
Jan P.G. Bergmanson OD, PhD, PhD hc, DSc, FCOptom, FAAO, FSLS (Chair of the organizing committee of the International Forum for Scleral Lens Research)a Melissa Barnett OD, FAAO, FSLS (President, Scleral Lens Education Society (SLS))b Shehzad A. Naroo BSc(Hons), MSc, PhD, FIACLE, FAAO, FBCLA, FEAOO, FCOptom (Editor-in-Chief, Contact Lens and Anterior Eye)c a Texas Eye Research and Technology Center, University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX 77204-2020, United States b Department of Ophthalmology, University of California, Davis Eye Center, 77 Cadillac Drive, Suite 101, Sacramento, CA 95825, United States c
Ophthalmic Research Group, School of Life and Health Sciences, Aston University, B4 7ET, UK