Pediatric Scleral Lenses: 21-Year Retrospective Review

Purpose: Retrospective study to review scleral lens outcomes in the pediatric population over a 21-year period, at a single clinical center.

Results: A total of 209 pediatric eyes (108 males and 101 females), distributed between 97 right and 112 left eyes, of which 147 eyes had ocular surface disease and 62 eyes had irregular cornea/refractive conditions, were treated with scleral lenses over a 21-year period. The mean age at the time of treatment initiation was 10.6 ± 2.6 years and at the time of the last evaluation recorded was 14.7 ± 4.0 years. One hundred and forty-seven eyes (70%) continued to wear scleral lenses at the time of review, with a mean duration of lens wear of 8.2 ± 4.6 years. Sixteen eyes (8%) discontinued lens wear, and of these, challenges with application and removal were the predominant reason for discontinuation. The lens wearing status of forty-six eyes (22%) was unknown. Mean LogMAR visual acuity at presentation for the entire cohort was 0.93 ± 0.74 and improved to 0.43 ± 0.58, p < 0.05 with scleral lens wear. LogMAR visual acuity at the last evaluation recorded was 0.4 ± 0.6, p < 0.05. The mean initial lens diameter of the full study cohort was 17.7 ± 1.2 mm, with a mean increase of 1.3mm (p = 0.0004) over the study period, to end with a mean final diameter of 18.2 ± 1.5 mm, at the time of the last evaluation recorded.

Conclusion: Scleral lenses are a viable option for therapeutic and visual rehabilitation applications in the pediatric population for both ocular surface disease and irregular cornea/refractive conditions. Most eyes continued to wear lenses over a 21-year review period. The mean final lens diameter was 18.2mm, suggesting that larger diameters do not appear to be a deterrent or obstacle for successful long-term outcomes in the pediatric population.