Purpose: Scleral lens practice has attracted more interest in the contact lens literature
over the last five years than over the last five decades put together. In the mid
1980s, traditional scleral lens designs were modernised in response to the introduction
of gas permeable materials with the emergence of new clinical methods, but essentially
preserving the objective of scleral bearing and corneal clearance. More recently,
new scleral lens styles have been developed more from a perceived need to increase
the diameter of corneal lenses. A myriad of limbal, and para-limbal lens designs,
mini, semi and full diameter sclerals are available to the practitioner, and once
again the essential fitting processes are under scrutiny. The size has become a critical
feature, but the comparative attributes of the various styles do not seem to be well
understood. Conforming to the traditional scleral lens fitting concept may not be
possible if the diameter is insufficient to allow scleral bearing and the traditionally
desired prerequisite of clearance well beyond the limbus. There has to be a bearing
surface somewhere, the characteristics and location determined in a large part by
the diameter. This presentation discusses the impact of bearing surfaces within and
just beyond the limbus for scleral lenses of various diameters and designs.
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© 2018 Published by Elsevier Inc.
