Home Building a Specialty Unveiling Two Decades of Pediatric Scleral Lens Success

Unveiling Two Decades of Pediatric Scleral Lens Success

headshot of Karen Carrasquillo
Dr. Karen G. Carrasquillo

A recently published study, Pediatric Scleral Lenses: 21-Year Retrospective Review, found that not only are scleral lenses viable for children, but they can also be transformative and safe. Lead author Karen G. Carrasquillo, OD, PhD, FAAO, FSLS, FBCLA, says that, previously, little research had been done on children and scleral lenses. But with the studies that have been, as well as the experience at BostonSight clinic, where she is senior vice president, clinical and professional affairs, she wasn’t surprised by the results. “There are probably fewer than 10 papers exploring long-term outcomes in pediatric scleral lens wearers. This study is unique because it examines 21 years of data.”

The findings are groundbreaking: 70% of the patients continued to wear scleral lenses at the time of the review, with an average wear time of eight years. For children referred for conditions like ocular surface disease (OSD, 70%) or irregular corneas (30%), the lenses proved indispensable.

A TESTAMENT TO MOTIVATION

One of the most striking takeaways was the dedication of these young patients. “You don’t get pediatric referrals for trivial conditions,” Dr. Carrasquillo explains. “These kids and their families are highly motivated because they need these lenses, and caregivers will do what’s needed to support and help their children. That’s critical for ophthalmology and optometry to understand.”

boy putting on a scleral lens by himself
Retrospective study finds that children can be adept and comfortable with scleral lenses. Photo courtesy of BostonSight.

Referrals came from across specialists, including cornea, bone marrow transplant specialists and pediatric ophthalmologists, amongst others. For primary care optometrists, Dr. Carrasquillo emphasizes this takeaway: consider scleral lenses earlier in the treatment hierarchy for persistent issues. “Sometimes, you might hesitate to refer a child for a contact lens, especially a scleral lens, but the data shows they’re safe and effective long-term. Application and removal training didn’t deter success.”

A CASE THAT CHANGED EVERYTHING

One story stands out in Dr. Carrasquillo’s memory from earlier in her career: an 11-year-old boy with a neurotrophic cornea following herpes simplex keratitis. “He had a massive central defect that wouldn’t heal, leaving thick scarring. We fit him with a scleral lens to protect the cornea and prevent further damage,” she says.

To everyone’s surprise, during follow-up visits in the first two or three years of wear, without the use of any adjuvants, the scar began to clear. Over the next decade, they documented the healing process through photos. “We initially thought of scars as permanent; now we think and refer to these as opacities,” she says. “This case opened the door to treating other children and adults for similar conditions. It led to other publications and changed our approach and understanding to corneal healing.”

CHALLENGING CONVENTIONAL WISDOM

The study also dispelled myths about lens size and safety. The perception has been that the larger diameter of a scleral lenses is not well-suited for smaller eyes. Early in this study period, however, on average pediatric patients were successfully fit with 17mm lenses. Over time, the average lens size used increased to 18.2mm. “The scleral lens community often fears going larger,” Dr. Carrasquillo says. “But our data showed that increased surface coverage improved outcomes. It challenges the notion that smaller lenses are always better for this patient population.”

IMPLICATIONS FOR CLINICAL PRACTICE

For practitioners hesitant to refer pediatric patients, the study provides compelling evidence to reconsider. “If you’re seeing persistent dry eye, corneal irregularities or other conditions unresponsive to less involved treatments, a referral for scleral lenses should be higher on the list,” Dr. Carrasquillo advises.

For scleral lens fitters who may shy away from considering scleral lenses for pediatric patients, “don’t be afraid. Scleral lenses for pediatric patients are safe and effective, and in many cases, the larger the lens, the better the outcome. These lenses can heal what we used to think was unhealable,” she says. “The commitment is worth it for the outcomes we’ve seen.”

Read the full study here.

 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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