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Keratoconus - How We Provide The Best Fit and Save Time With Less Refits Author: Kim Raharja, OD

  • Writer: Kim Raharja
    Kim Raharja
  • Jul 25, 2023
  • 3 min read

Updated: Jan 12

Enhancing Vision and Comfort: The Impact of Scleral Profiler and Anterior Segment OCT in Keratoconus Management


The Role of Scleral Profiler

The Eaglet Eye Surface Profiler (ESP) offers outstanding precision in corneo-scleral profilometry, facilitating faster, customized, and more accurate lens fittings. The data collected is translated into 3D height maps and can be sent to the lens manufacturer for the most precise fit.

ESP BENEFITS

  • Versatile: Engineered for all specialty contact lenses: Scleral, OrthoK, GP, Soft, and Hybrid.

  • Full Ocular Surface: Measures the cornea from limbus to limbus, and the sclera up to a 20mm diameter.

  • Fast and Easy to Use: Captures over 500,000 data points in a single shot without stitching, interpolation, or extrapolation.

  • Fewer Refits: Integrated algorithms select the initial lens for over 50 lenses from more than 25 labs.

  • Precise: High precision designed for various lenses: 2μ in the cornea & 10μ in the sclera.


Elevation map from Eaglet ESP Eye Surface Profiler
Elevation map from Eaglet ESP Eye Surface Profiler
Example of Scleral - First and Final Fit based on Eaglet Profilometry
Example of Scleral - First and Final Fit based on Eaglet Profilometry

The Advantages of Anterior Segment OCT

Anterior Segment OCT (AS-OCT) provides significant benefits for scleral lens fitting, offering high-resolution, non-contact imaging to visualize the precise lens-eye relationship. It ensures optimal central clearance (vault), limbal clearance, and edge alignment for comfort and corneal health, especially in complex cases such as keratoconus or post-surgical eyes where biomicroscopy falls short. It detects subtle corneal anomalies, assesses tear film dynamics, confirms proper lens landing, and monitors for complications like limbal touch, leading to more accurate fittings and healthier outcomes.

Key Advantages:

  • Visualizes the Unseen: Allows practitioners to observe microscopic interactions, such as the true vault over the cornea and the landing zone on the sclera, which are challenging to assess with traditional slit-lamp exams.

  • Precise Clearance Measurement: Accurately measures central corneal clearance (vault) and limbal clearance, ensuring adequate space for the cornea while preventing limbal impingement, crucial for avoiding complications.

  • Confirms Edge Alignment: Verifies the correct alignment of the scleral lens skirt with the scleral surface, preventing edge lift or excessive pressure.

  • Detects Corneal Irregularities: Reveals subtle corneal topography, including epithelial thinning or scars, guiding lens design for improved vision and corneal protection.

  • Evaluates Tear Film: Assesses the tear reservoir beneath the lens and its dynamics.

  • Monitors Corneal Health: Detects early signs of complications like corneal edema or neovascularization from poor fitting.

  • High-Resolution & Non-Contact: The high resolution and non-invasive nature reduce patient discomfort and artifacts, enhancing image quality, as noted by Healio and ScienceDirect.com.

  • Efficient Fitting: Facilitates faster, more informed adjustments, potentially reducing the number of lens remakes needed, as shown in this case study.

What it Measures:

  • Central Clearance (Vault): Distance between the lens and corneal apex (ideally ~200 microns).

  • Limbal Clearance: Space around the limbus (edge of cornea).

  • Edge Lift/Alignment: Interaction of the lens edge with the sclera.

  • Corneal Thickness & Shape: Epithelial and stromal thickness maps.

In essence, AS-OCT transforms scleral lens fitting from subjective assessment to objective, quantitative analysis, optimizing comfort, vision, and long-term eye health.

  1. Monitoring Progress: Regular OCT scans allow practitioners to track disease progression and adjust lens fit or treatment plans as needed, enhancing long-term patient outcomes.


Conclusion

Technological advancements have revolutionized keratoconus management. The Scleral Profiler and Anterior Segment OCT enable eye care professionals to tailor a personalized approach for each patient. This method combines the comfort of stable scleral lenses with the precision of imaging tools, improving visual acuity and overall quality of life for keratoconus patients. As technology continues to advance, more effective solutions for managing this condition are anticipated. At Atlanta Eye Associates, we are committed to providing our patients with the best possible care by staying informed on the latest technological advancements.

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