Are you struggling with hard-to-fit eyes or looking for a more comfortable alternative to traditional contact lenses? Fenestrated scleral lenses might be the solution you’ve been searching for. They are useful to reduce suction forces on a scleral lens, which may be causing eye rednesss. Fenestrations are gaining in popularity but are still rare to do. In this comprehensive guide, we’ll explore how these innovative lenses can transform vision and comfort for patients with complex corneal conditions.
What Are Fenestrated Scleral Lenses?
Fenestrated scleral lenses are specialised contact lenses designed for comfort and increased breathability. Unlike regular contact lenses, these larger lenses have tiny, precisely placed holes (fenestrations) that allow your eyes to breathe easier. These fenestrations may range from 0.2 to 0.5mm in diameter, and are custom designed for each patient’s unique eye shape and needs.
Why Do We Use Fenestrated Scleral Lenses?
1. Improved Oxygen Flow to Your Cornea
Technical Details:
- Fenestrations create small bubbles between the lens and the cornea.
- These bubbles act as reservoirs for fresh, oxygenated tears.
- As the eye moves, these bubbles encourage tear exchange, bringing oxygen-rich tears into contact with the cornea.
- This mechanism significantly enhances oxygen transmission to the cornea, especially beneficial for compromised corneas.
Patient Benefits:
- Increased oxygen supply to the cornea
- Reduced risk of corneal hypoxia
- Improved long-term corneal health
- Enhanced comfort during extended wear
Ideal for:
- Patients who’ve had corneal transplants
- Those with corneal ectasia (like keratoconus)
- People with compromised corneal health
- Patients requiring extended wear times
How It Works:
- The tiny fenestrations (0.2 to 0.5 mm in diameter) allow small amounts of tears to pass through the lens.
- These tears form micro-bubbles between the lens and the cornea.
- As you blink and your eye moves, these bubbles shift, creating a pumping effect.
- This pumping action brings fresh, oxygenated tears into contact with your cornea.
- The result is a constant supply of oxygen to your cornea, even with a large scleral lens covering it.
2. Enhanced Tear Exchange
Technical Details:
- Fenestrations promote tear circulation beneath the lens.
- Helps maintain a healthy ocular surface microenvironment.
Patient Benefits:
- Reduced debris accumulation
- Decreased risk of inflammatory responses
- Improved comfort and visual stability
Ideal for:
- Patients with heavy mucus production
- Those prone to debris accumulation under standard scleral lenses
- Anyone experiencing mid-day fogging with traditional scleral lenses
3. Reduced Suction for Greater Comfort and Less Red Eyes
Technical Details:
- Fenestrations help equalise pressure between the pre- and post-lens tear film.
- Can reduce the force required for lens removal.
- Reduced red eyes from a tight fitting lens
Patient Benefits:
- Easier lens application and removal
- Reduced discomfort associated with lens suction
Ideal for:
- Patients who find traditional scleral lenses difficult to remove
- Those experiencing discomfort due to lens adhesion
- People with eyes sensitive to pressure
The Importance of Optimised Fenestration Design
One of the most critical aspects of fenestrated scleral lenses is the precise customisation of the fenestrations themselves. The size, number, and location of these tiny holes can significantly impact lens performance and patient outcomes.
Size and Location: A Delicate Balance
For Eye Care Professionals:
- The size and placement of fenestrations directly impact bubble formation.
- Optimal bubble size and distribution are crucial for efficient oxygen exchange.
- Too large or too many fenestrations may compromise lens stability.
- Too small or too few may not provide adequate oxygenation.
Considerations for Optimisation:
- Scleral Shape: The unique shape of each patient’s cornea and sclera influences ideal fenestration placement.
- Tear Dynamics: Understanding the patient’s tear film behaviour helps in determining the most effective fenestration pattern.
- Oxygen Demand: Patients with higher oxygen demands may benefit from different fenestration configurations compared to those with milder conditions.
- Suction Effects: The location and size of fenestrations can be adjusted to modulate suction, balancing comfort with lens stability.
For Patients: Why Fenestration Design Matters
If you’re considering fenestrated scleral lenses, here’s what you should know: the tiny holes in your lenses are carefully designed to create just the right amount of bubble formation. These bubbles are key to keeping your eyes healthy and comfortable. Your optometrist will fine-tune the design to ensure you’re getting the oxygen your eyes need.
The Fitting Process
For optimal results, fitting fenestrated scleral lenses requires a strategic approach:
- Initial Assessment: Comprehensive evaluation of the patient’s corneal condition, tear film, and overall ocular health.
- Design and Customisation: Based on the assessment, an initial lens design is created. Fenestrations may be hand drilled in the practice or laser drilled at the laboratory.
- Fitting and Evaluation: The lens is fitted, and its performance is carefully evaluated, including the effectiveness of the fenestrations.
- Refinement: Adjustments to fenestration size, number, or location are made based on clinical findings.
- Follow-up Care: Regular check-ups to ensure ongoing optimal performance and make any necessary adjustments.
Are Fenestrated Scleral Lenses Right for You?
Fenestrated scleral lenses might be an excellent option if:
- You’ve had a corneal transplant
- You have keratoconus or other corneal irregularities
- You’re experiencing discomfort or vision issues with traditional contact lenses
- You have severe dry eye or other ocular surface diseases
- You’re recovering from eye surgery
However, they’re not suitable for everyone. Your optometrist will consider factors such as:
- Your specific eye condition
- The shape and health of your cornea
- Your lifestyle and wearing habits
- Any previous experiences with contact lenses
Next Steps
If you think you might benefit from fenestrated lenses, please bring in your current lenses to your consultation. If you are an optometrist and have have patients who might benefit from fenestrated scleral lenses, we welcome your referrals. When referring patients, consider including:
- Detailed corneal topography maps
- Any relevant history of corneal surgeries or treatments
- Specific concerns about oxygen transmission or tear exchange
- Patient’s experience with previous contact lens modalities