morning . The treatment had notably improved her behavior , according to her parents ’ reports . It is not rare that mini-scleral lenses have such a positive impact , in that they restore visual acuity as well as ocular comfort .
Sjögren ’ s syndrome , persistent epithelial corneal defects , Steven ’ s Johnson Syndrome , Graft Versus Host Disease , ocular cicatricial pemphigoid , atopic keratoconjunc-tivitis or other corneal irregularities resulting in poor vision are just a few examples of additional condi-tions that can be managed with the help of LDRGP . 8 Recent reports describe using LDRGP to deliver pharmacologic agents to the ante-rior surface of the eye . In the case of neurotrophic keratopathy where persistent corneal epithelial defects and even ulceration can occur , an-tibiotics can be instilled in the lens and placed directly on the eye . 17 This helps the ocular surface recover and heal properly . Patients are extremely grateful when the practitioner finds a successful solution to their problem .
It is well-known that LDRGP lenses are effective in the treatment of complex cases such as neurotrophic keratopathy secondary to Möbius syndrome . These lenses thus provide optimal treatment for this patient ’ s ocular surface disease .
Conclusions
Fitting of mini-scleral contact lenses succeeded in treating bilateral neurotrophic keratopathy with corneal scarring that penalized visual acuity . Such lenses would be an ideal solution in any case of neurotophic keratopathy . It was extremely rewarding to use these lenses and thereby provide clear vision to a patient who had been struggling for many years with an ocular surface condition and consequently poor vision .
With the increasing recent interest of clinicians and manufacturers , mini-scleral lenses are becoming far more “ mainstream ” in contact lens practice . As optometrists , we should strive to continuously update our expertise in the area of contact lens design , thereby providing our patients with the latest lens technology and best solution for their signs and symptoms .
References
1 . Miller MT , Owens P , Chen F . Möbius and Möbius-like syndromes ( TTV-OFM , OMLH ). J . Pediatr Ophthalmol Strabismus . 1989 Jul-Aug ; 26 ( 4 ): 176-88 .
2 . Arturo C , Mora P , Neri A , Favilla S , Sadun AA . Ophthalmologic and systemic features in Möbius syndrome . Ophthalmology . 2011 Aug ; 118 ( 8 ): 1518-523 .
3 . Goldblatt D , Williams D . I am smiling : Mobius syndrome inside and out . J Child Neurol 1986 Jun ; 1 ( 1 ): 71-78 .
4 . Graziadio C , Lorenzen MB , Rosa RFM , et al . New report of a familial case of Moebius syndrome presenting skeletal findings . Am J Med Genet Part A . 2010 ; 152A ( 8 ): 2135 .
5 . Gorlin RG , Pinborg J , Cohen . Syndromes of the head and neck . Edition 2 . New York , McGraw Hill , 1976 .
6 . Dartt DA . Corneal Nerves : Anatomy . Ocular Periphery and Disorders . San Diego : Academic / Elsevier , 2011:150 .
7 . A Brief History of Scleral Lenses . History | Scleral Lens Education Society . < http :// www . sclerallens . org / history > Feb 18 , 2013 .
8 . van der Worp , EA Guide to Scleral Lens Fitting . [ Forest Grove , Ore .]: [ College of Optometry , Pacific University ], 2010 : 1-4 .
9 . Medmont Pty Ltd . MEDMONT E300 CORNEAL TOPOGRAPHER USER MANUAL . VICTORIA : © MEDMONT , 2012 .
10 . Gardner D , Zimmerman A . Myopic shift secondary to hybrid lens wear . Contact Lens Spectrum . 2012 Jun ; 27 : 44-48 .
11 . Michaud L , Woo S , Dinardo-Lotoczky A , et al . Clinical evaluation of a large diameter rigid-gas permeable lens for the correction of refractive astigmatism . American Academy of Optom . 2012 : Poster ; 125085 , Phoenix .
12 . Baldwin B and Moyer S . AS-OCT and the specialty contact lens . Review of Cornea and Contact Lenses . 2012 Apr : 32-34 .
13 . Gungor I , Schor K , Rosenthal P , Jacobs DS . The Boston scleral lens in the treatment of pediatric patients . JAAPOS . 2008 Jun ; 12 ( 3 ): 263-7
14 . Holden BA , Mertz GW . Critical oxygen levels to avoid corneal edema for daily and extended wear contact lenses . Invest Ophthalmol Vis Sci . 1984 Oct ; 25 ( 10 ): 1161-7 .
15 . Rah MJ , Walline JJ , Jones-Jordan LA , et al . Vision specific quality of life of pediatric contact lens wearers . Optom Vis Sci . 2010 Aug ; 87 ( 8 ): 560-6 .
16 . Ma JJK , Morad Y , Mau E , Brent HP , Barclay R and Levin AV . Contact lenses for the treatment of pediatric cataracts . Ophthalmology . 2003 Feb ; 110 ( 2 ): 299-305
17 . Lim P , Jacobs DS , Rosenthal P . Treatment of persistent corneal epithelial defects with the Boston ocular surface prosthesis and an antibiotic adjunct . 2009 . ARVO poster ; 653
48 Vol 75 | No 2 2013 C a n a d i a n J o u r n a l o f O p t o m e t r y | R e v u e c a n a d i e n n e d ’ o p t o m é t r i e