Scleral lenses have revolutionized the way our eye doctors approach complex corneal and ocular surface diseases, providing a tailored solution built on precision and advanced imaging. Using the high-resolution capabilities of anterior segment optical coherence tomography (AS-OCT), our eye doctors can accurately gauge the sagittal height of the cornea and sclera, ensuring a meticulous lens fit. This innovative method eliminates much of the trial-and-error traditionally associated with lens fitting, promoting both comfort and optimal visual outcomes.

Understanding Anterior Segment OCT in Scleral Lens Assessment

Anterior Segment OCT is a high-resolution, non-contact imaging modality that offers clear, detailed cross-sectional views of the eye’s anterior structures. Unlike traditional topography, which provides only a curvature map, OCT measures the true sagittal height, the vertical distance from a defined chord line to the corneal apex. This measurement is crucial because scleral lenses vault over the cornea to rest on the sclera, making precise data on the eye’s depth indispensable to achieving the perfect fit.

The Science Behind Sagittal Height Measurement

Sagittal height is measured using a specific chord length (for example, 10 mm or 15 mm) on the eye’s surface, and the resulting value determines how much clearance will exist between the lens and the cornea. This clearance, termed the central vault, is critical: too little clearance may lead to corneal bearing and discomfort, while too much can result in lens instability and an unwanted visual experience. Anterior Segment OCT excels at capturing these minute measurements, enabling our eye doctors to match lens designs to the unique anatomy of each patient’s eye.

Importance of Precise Sagittal Height in Lens Fitting

Unlike contact lenses that rest directly on the cornea, scleral lenses vault over the sensitive corneal surface, making the accurate measurement of sagittal height all the more critical. The exact placement of the lens depends on knowing the vertical profile of the eye, which, in turn, ensures the ideal fit that maximizes comfort and minimizes risks. By addressing the vertical dimension of the eye, our eye doctors can tailor the lens design to avoid complications such as corneal touch or excessive edge lift.

Key Clinical Benefits of Anterior Segment OCT in Scleral Lens Assessment

Accurate Central Vault Measurement

With AS-OCT, our eye doctors can clearly visualize and quantify the central clearance between the lens’s posterior surface and the corneal apex. Typically, an initial vault target of 200–300 microns is established to ensure that the lens doesn’t bear on the cornea, thereby reducing irritation and potential complications.

Limbal Clearance Evaluation

Maintaining adequate clearance around the limbus is essential to protect the delicate stem cells located there. OCT measurements help prevent mechanical trauma and hypoxic conditions that can arise from inappropriate lens fit.

Edge Alignment and Scleral Landing Assessment

AS-OCT imaging allows our eye doctors to assess how the haptics of the scleral lens align with the sclera. Detecting issues like excessive edge lift, conjunctival blanching, or localized pressure ensures that the lens not only fits well but remains comfortable and stable during wear.

Sagittal Height-Based Lens Selection

The precise data provided by OCT directly informs the diagnostic lens selection process from standardized sets or customizes a lens design through specialized software. This tailored approach contributes to reducing the number of fittings needed to achieve an optimal configuration.

Monitoring Long-Term Fit

By capturing a series of OCT scans, practitioners can track how the lens settles over time (often a reduction of 100–150 microns) and make necessary adjustments to maintain consistent clearance and comfort.

Workflow of Scleral Lens Assessment Using AS-OCT

Integrating AS-OCT into the scleral lens fitting process involves several key steps that allow our eye doctors to precisely evaluate each patient’s anterior eye profile. This structured approach ensures that every aspect of the fit, from the initial selection to long-term adaptation, is carefully monitored and adjusted as needed.

Pre-Fit Imaging

Before selecting or fitting any lens, a comprehensive imaging session takes place. High-tech OCT captures sagittal profiles at different chord lengths, such as 10 mm and 15 mm. These initial measurements provide crucial baseline data that inform subsequent lens selection, ensuring that the lens design harmonizes with the unique topography of the patient’s eye.

Post-Lens Application Imaging

Once the lens is applied, it is crucial to re-assess using OCT after the lens has settled, typically between 30 to 60 minutes post-application. During this period, the lens may settle slightly, and the OCT images capture the new, stabilized configuration. This scan is invaluable as it allows verification of the central vault, limbal clearance, and the alignment where the lens meets the sclera. With immediate visual feedback, any initial deviations can be corrected swiftly.

Initial Lens Design and Selection

With OCT data in hand, our eye doctors can make an informed decision regarding the starting lens parameters. Using the precise measurements of the eye’s sagittal height, the practitioners select an appropriate diagnostic lens. If needed, the data is also used to input into specialized lens design software, refining the initial parameters for a more exact match to the patient’s anatomy. This step minimizes the traditional trial period often associated with scleral lens fitting.

Adjustment and Final Verification

Based on the post-application OCT imaging, adjustments to the lens design may be necessary. Whether tweaking the vault height or refining the edge alignment, every modification is closely guided by the detailed images provided by OCT. After modifications, a final scan ensures that the adjusted parameters meet the desired criteria, delivering a lens that supports long-term comfort and optimal visual performance.

Advanced Applications and Future Directions

AS-OCT is not only a tool for initial lens fitting, it also offers valuable insights for long-term management and advanced applications. Its use expands the capabilities of our eye doctors to address complex cases that standard topography might overlook.

Post-Surgical and Irregular Corneas

Eyes that have undergone corneal grafts or those not conforming to typical anatomical patterns benefit immensely from OCT. In these instances, traditional mapping methods can fall short. The detailed imaging provided by OCT captures subtle asymmetries and elevation differences, enabling our eye doctors to design a lens that fits even the most irregular corneal surfaces with precision, thereby enhancing patient comfort and safeguarding ocular health.

Hybrid Lens Crossovers and Comparative Assessments

Not every patient is an ideal candidate for scleral lenses, and sometimes the best approach may involve a transition to hybrid lens options. OCT data provides our eye doctors with a clear comparison between scleral and hybrid lens fits in borderline cases. This information is key in making the most informed decision to ensure optimal patient comfort and visual acuity.

Applications in Surgical Planning

For patients who might require future corneal surgeries, baseline OCT imaging offers a baseline reference point. By documenting the eye’s initial state and how it adapts to scleral lens wear, our eye doctors can create a comprehensive record. This documentation is especially critical when planning surgical interventions, ensuring that any changes in the eye’s anatomy are thoroughly evaluated and accounted for in future treatments.

Looking Ahead: Integrating New Technologies

The future of scleral lens fitting is bright, with AS-OCT at the forefront of emerging technologies. Ongoing advances in imaging software are paving the way for AI-assisted fitting platforms that may eventually support real-time lens modeling. These systems could predict outcomes and even streamline the ordering process, allowing for a seamless integration of technology and patient care. As these innovations develop, patients can expect even more refined and personalized scleral lens solutions.

Optimizing Scleral Lens Fitting for Success

High-Tech Scleral Lens Assessment from Anterior Segment OCT demonstrates a blend of precision and patient care that is truly beneficial in modern eye care. The integration of high-tech imaging into every step of the scleral lens fitting process means that our eye doctors can maintain the highest standards of both safety and comfort.

Establishing a Customized Fit

One of the standout strengths of using AS-OCT is the ability to establish a customized fit for each patient. Each eye is unique, and traditional measurements sometimes have limitations that can lead to prolonged adjustment periods. With AS-OCT, measurements are highly accurate, tailoring each lens to the eye’s specific anatomical features. This personalized approach is especially important for those with atypical corneal geometries, where even minor errors in measurement could result in discomfort or suboptimal vision.

Minimizing Complications and Enhancing Comfort

By focusing on precise measurements and applying advanced imaging techniques, our eye doctors can proactively minimize the risk of complications associated with scleral lens wear. For instance, ensuring adequate limbal clearance using OCT data is a direct boon to ocular surface health by avoiding mechanical trauma and hypoxia. Moreover, proper assessment of edge alignment through OCT helps in reducing issues such as redness or localized pressure, contributing to a more comfortable lens experience overall.

Streamlining the Fitting Process

The efficiency gains from the use of AS-OCT are significant. Traditionally, fitting scleral lenses required multiple visits and extensive trial periods. Now, with high-tech imaging providing accurate and immediate data, the overall process is streamlined. Our eye doctors can quickly determine the best initial lens design and reliably predict post-fitting parameters. This enhanced workflow means that patients receive a final, well-fitted lens sooner, reducing inconvenience and leading to higher patient satisfaction.

Long-Term Success Through Regular Monitoring

Even after the initial lens fitting, continuous monitoring is key to ensuring that the scleral lenses continue to meet the patient’s needs. The ongoing application of AS-OCT provides a dynamic view of how the lens interacts with the eye over time, capturing changes in central vault, limbal clearance, and overall fit.

Tracking Lens Settling and Adaptation

Scleral lenses may settle slightly after initial application, typically showing a reduction in central vault by 100–150 microns. With OCT, these changes can be monitored precisely. This tracking is crucial not only for immediate adjustments but also for understanding how the lens interacts with the ocular surface over extended periods. Regular assessments ensure that any significant deviations are caught early, keeping the lens performance both stable and comfortable for the patient.

Adapting to Changes in Ocular Anatomy

As part of long-term ocular care, the eye’s anatomy may change due to various factors such as aging, minor fluctuations in corneal shape, or surgical interventions. The high-tech imaging provided by AS-OCT offers reliable data that our eye doctors can use to re-evaluate and adjust scleral lens parameters as needed. This ongoing adaptability helps prevent complications while ensuring that the patient continues to enjoy the benefits of optimal lens alignment and enhanced vision quality.

Final Summary and Next Steps

The journey toward an optimal scleral lens fitting begins with precise measurements and continues with vigilant monitoring using high-tech imaging. This comprehensive approach ensures long-term comfort, safety, and improved visual outcomes. For any further questions or personalized advice, please call our office.

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Technical Aspects of the Scleral Lens Fitting Process

Determining whether you’re a good candidate for scleral lenses starts with a detailed map of your cornea and precise measurements of your eyes. Our eye doctors use advanced technology to choose the ideal lens design and size for your unique eye shape. Follow-up appointments help fine-tune the lenses to ensure maximum comfort and clear vision. This personalized evaluation sets scleral lenses apart from other options, offering a solution tailored to your specific visual and comfort needs.

Top-Rated Specialty Contact Lens Center in Orange County

At Insight Vision Center Optometry, we’re proud to serve the diverse communities of Orange County and even patients who travel from abroad for expert specialty contact lens care. Conveniently located in Costa Mesa, our clinic is easily accessible from Newport Beach, Huntington Beach, Irvine, Santa Ana, and beyond.

Our world-class team of specialists has extensive experience fitting contact lenses for even the most challenging cases. With cutting-edge technology and a true passion for improving lives, we deliver the highest level of care from early diagnosis to advanced treatment options.

As Orange County’s leading experts in scleral and specialty contact lenses, we’re committed to helping you achieve the best possible results. Whether you need advanced lenses or expert guidance, we’re here to help you see the world clearly again.

Insight Vision Center Optometry is a proud member of Vision Source, the premier network of private practice optometrists.

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Insight Vision Center Optometry has truly transformed my eyecare experience over the past year. Under the expert care of Dr. Chen, Dr. Schramm, Dr. Lam, and Dr. Mai, I've received unparalleled attention and personalized service. Their commitment to excellence extends beyond the doctors to the outstanding admin and tech team who ensure a seamless and efficient visit every time.

The level of expertise, professionalism, and genuine care exhibited by the entire staff sets Insight Vision Center Optometry apart. From thorough examinations to comprehensive explanations of my eye health, they have created an atmosphere of trust and confidence. It's not just about eye care; it's about an extraordinary commitment to the well-being of their patients.

I wholeheartedly recommend Insight Vision Center Optometry to everyone seeking top-notch optometric services. It's more than an eye clinic; it's a place where your vision is valued, and your experience is exceptional. This team has undoubtedly set the standard for excellence in eyecare.

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Dr. Mai and the entire personnel are amazing! Extremely polite, kind and professional. In addition, I can now see 20/20!!! Thank you, thank you all

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Dr. Schramm is stellar. He really cares about his patients. Great staff. Scleral lenses are life changing.

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My first eye exam in fifteen years. I am so thankful that I found Insight Vision Center. Dr. Lam and staff made me feel like a welcome guest. My eye exam revealed very minor blurriness and Dr. Lam did not pressure me into purchasing eyewear for a condition not necessitating glasses… yet. Maybe next year? I am getting older. They took my VSP insurance. Yay!

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