Clinical Effect of Tear Layer Thickness on Corneal Edema During Scleral Lens Wear

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 clearanc