Although all of the options are feasible, we proceeded to schedule the patient for a scleral lens fitting.
A hydrogen peroxide care regimen had been tried, with no improvement in the amount of lens deposition.
Although daily disposable lenses are an option, many of the designs have a significantly lower modulus than the patient's current contact lenses. A potential exception to this rule is a daily disposable lens with a water gradient technology and a design that retains a high level of moisture at the surface of the lens. It may show promise with these types of patients. Unfortunately, it is currently unavailable in hyperopic powers and would not help our patient with her refractive needs.
Lacrisert was previously used with this patient, with an unfavorable response.
Discontinuing contact lenses was discussed, but the patient was too uncomfortable without the lenses. If this was the only option, she would continue with her current wearing experience rather than discontinue lens wear.
The patient was fitted with a custom stable scleral lens. She did remarkably well during the fitting process and felt that her vision was significantly clearer than in her previous lenses. In addition, she felt that her eyes were significantly more comfortable. The lenses were ordered and dispensed to the patient.
Two weeks after the lenses were dispensed, the patient returned for a follow-up visit. Her vision and comfort with the scleral lenses continued to be superior to her previous lenses. Her punctate epitheliopathy improved significantly in both eyes, and the patient noted that her eyes did not seem as sensitive to light. She continues to wear her scleral lenses successfully.
Medscape Optometry © 2013
Cite this: A 57-Year-Old Woman With Sjögren Syndrome - Medscape - Oct 28, 2013.