Modern clinical use of Mini- scleral contact lenses WCO VI – Boston Dr Langis Michaud OD M.SC. FAAO (Dipl) Associate Professor

Disclosure  The author of this poster have received research funding from Laboratoires Blanchard (Sherbrooke, Québec)  There is no other financial interest in the subject matter of this poster.

Classification ( Dr Sindt, o.d.)  Corneo-scleral contact lenses : mm  Semi-scleral lenses : 13.6 –14.9 mm  Mini-scleral: 15.0 – 18.0 mm  Scleral lenses mm

Mini-scleral lens modern usage  Graft vs Host disease (GVH)  Atopic keratoconjunctivitis  Corneal disorders /surface diseases / dystrophies  Corneal ectasia (KC/PMD)  Post-graft  Post-refractive surgery  Intolerance to other modalities  High refractive errors (myopia, astigmatism)

Mini-scleral applications Patient with corneal dystrophy (Groenouw I) OD and a corneal graft OS

Clinical advantages of Mini-scleral lenses  To improve visual acuity  To increase lenses comfort and stability  To favor oxygen transmissibility  To help to restore ocular health Valuable option for chronic ocular surface diseases

Reasons for failure  Handling too difficult (40%) Age, dexterity  Discomfort (25%) Becomes a symptom of a bad fit…. Seal off of the conjunctiva or the limbal area  No better visual outcome (15%) Vision problem not related to corneal surface  Cost (12%)  Other systemic causes – toxicity to solutions, intolerance, etc (8%)

Photo gallery Corneal scarring secondary to a chronic inflammation of the cornea Uncorrected V.A. 6/40 BCVA with Mini-scleral c.l. 6/7,5 Fitted with a MSD 15,8 lens / DD profile

The best alternative  Acculens – Maxim 4 and 5 (Denver, Colorado)  The easiest mini-scleral lens to fit nowadays (diam from16 to 17,5 mm)  Comfortable – predictable  Extended range of parameters available

Conclusion  Mini-scleral lenses are part of modern treatment of corneal ectasia, post-surgery corneal restoration and chronic ocular surface disorders.  Other applications include refractive errors or intolerance with other type of contact lenses  Relatively easy to fit with modern designs Learning curve exists however

The last word  To fit Mini-Scleral lenses is a rewarding process  Better results are achieved over time  Mini-scleral lenses should not be considered the last option any more….  More info:

Author biography  OD- U de Montréal (1986)  M.SC. – U de Montréal (1998)  3rd cycle- short program ENAP Montréal - Public health (2006)  Associate Professor (2001-…) École d’optométrie de l’Université de Montréal Head- contact lens department- clinical studies in contact lenses  Fellow American Academy of Optometry (1998)  Diplomate- Cornea and Contact lenses (1995) Publications list available upon request poster and lectures at ARVO, AAO and AOA, nationally and internationally Research interests Cornea, anterior segment Specialty contact lenses Fabry’s disease and MPS Contact ext 8945