Scleral lens an important tool in many 'last resort' scenarios

Dr. Rosenthal invented the technology and is founder and president of the Boston Foundation for Sight, a 501(c)3 nonprofit organization dedicated to developing sight-restoring contact lenses for persons disabled by corneal diseases.

Patients in whom management of severe ocular surface disease is the primary indication have experienced dramatic relief from pain and photophobia and also benefit from the effectiveness of its corneal liquid bandage in promoting the healing of corneal erosions, persistent full-thickness epithelial defects, and filaments when all other measures have failed. According to Dr. Rosenthal, it has been more effective than extensive tarsorrhaphy in many cases. Its ability to mask irregular astigmatism and improve vision is an additional benefit for these eyes.

With rigorous screening, involving careful patient evaluation and trial lens fitting, together with an advanced computer-aided method of lens design, success-which is measured by continued lens wear-exceeds 90% for both vision enhancement and ocular surface disease indications, according to Dr. Rosenthal.

"Wearing these lenses is a burden because insertion and removal can be awkward and frustrating, the care regimen is time-consuming, and many patients with severe dry eye are required to remove and clean them periodically when accumulated surface debris interferes with vision," Dr. Rosenthal said. "Therefore, continued use of this device is a broad and important marker of success because one can conclude that their benefits far outweigh these disadvantages."

Patients benefit from technology

The Boston Scleral Lens is a welcome addition to the ophthalmologist's armamentarium, according to Ernest W. Kornmehl, MD, medical director, Kornmehl Laser Eye Associates, Boston.

"The lens can offer benefit when there seems to be little hope for a select group of patients. This device is significant considering the numbers affected nationwide," Dr. Kornmehl said. "Ophthalmologists need to be aware of this valuable technology and it is deserving of our support."

One of the most dramatic illustrations of the value of the lens is provided by the experience of patients with severe dry eye secondary to chronic graft-versus-host disease.

"They have been incredibly disabled by constant, severe pain and photophobia, sometimes for years, and must be examined in dim ambient light," Dr. Rosenthal said. "Yet, they are able to open their eyes without pain in a fully lit room within minutes after the initial trial lens insertion. It is an amazing phenomenon."