1. LENS DYNAMICS, INC.

2. SCLERAL HISTORY Original contact lens Hand ground glass lenses Fit by casting a mold of the cornea

3. EARLY SCLERAL PERFORMANCE Difficult to fit Hard to manufacture and reproduce Corneal hypoxia Very short wearing times Corneal molding – The negative kind

4. SCLERAL DEFINED Mini-Sclerals – 12.5mm to 14.5mm Medium Range Sclerals – 15.0mm to 18.0mm Full Sclerals – 18.5mm to 28.0mm

5. SCLERALS – FIRST OR LAST RESORT?

6. WHY FIT A SCLERAL LENS? THE PRO: To vault highly irregular corneas To provide better visual acuity than soft lenses To prevent lost lenses New Oxygen permeable materials

7. WHY FIT A SCLERAL LENS? THE CON: Harder to fit Harder to insert and remove Can reduce metabolic waste removal Potential for hypoxia Harder to fit

8. THE PRACTICAL: First or Last Resort as a design? Who fits sclerals at all? Who fits sclerals as the design of First choice? Who fits sclerals as a design of Last resort?

9. THE DESIGN: 13.0mm, 13.5mm, 14.0mm Lathe cut on DAC ALM lathes Spherical back and front surfaces Normally NOT fenestrated

10. HOW TO FIT Start with a base curve close to average Ks Trial for best alignment pattern as possible Be sure there is NO conjunctival drag Do spherical over-refraction Need 0.5mm of movement

11. FITTING TIPS Fill concave side with saline/wetting drops into posterior of trial lens Dip fluorescein strip into solution Insert using 2 fingers to handle the trial lens with patient looking at floor Low riding lens – select flatter base curve Flatten base curve to solve edge tightening

12. CASE HISTORIES

13. 48 years old, Caucasian male, OD cornea Can’t use bi-toric Quadrant Specific base curve not indicated Temporal/superior area eliminates reverse curve design Select Semi-Scleral 13.5 design CASE 1

14. 48 years old, Caucasian male, OD cornea Average K is 47.00 D. or 7.18mm Select 7.20mm BC from trial set, 13.5mm -4.00 Acceptable fit with -2.25 over-refraction CASE 1

15. 22 years old, African American male, OS cornea CASE 2 Superior, peripheral area too steep for Quadrant Specific base curve Bi-toric not indicated Select Semi-Scleral 13.5 design

16. 22 years old, African American male, OS cornea Average K is 47.00 D. or 7.18mm Select 7.20 BC from trial set, 13.5mm Lens too tight at edge and too much vaulting CASE 2

17. 22 years old, African American male, OS cornea Select trial lens 0.2mm flatter or 7.40mm Acceptable fit Perform spherical over-refraction CASE 2

18. 31 year old Caucasion female, OD cornea Bi-toric not indicated Flatter areas too narrow for Quadrant Specific base curves Reverse curve design not indicated Select Semi-Scleral 13.5 design CASE 3

19. 31 year old Caucasion female, OD cornea Average K is 46.25 D. or 7.30mm Select 7.30mm trial lens from trial set Low riding lens-select flatter base curve CASE 3

20. 31 year old Caucasion female, OD cornea Select 7.50mm base curve from trial set Acceptable fit with lens properly positioned Perform spherical over-refraction CASE 3

21. Questions?