Case Report: Profilometry Guided Scleral Lenses for High Corneal and Scleral Toricity

Introduction Innovations in imaging technology of the ocular surface have provided eye care practitioners with more precise data when fitting scleral lenses. Utilization of corneoscleral profilometry can supplement the traditional process of scleral lens fitting with diagnostic fitting sets, particularly for patients with corneal and scleral irregularities. This technology may help provide a best-fit lens that matches the ocular surface to improve patient outcomes. Case Report A patient was referred for a specialty contact lens evaluation. Corneal tomography and refractive data showed 8 diopters of corneal and refractive astigmatism. Tomography did not reveal significant pathology consistent with high astigmatism. Scleral lenses were determined to be the best vision correction option. The patient was fit in-office with several large diameter diagnostic scleral lenses. However, none of the lenses would remain inserted on the eye, even with advanced toric landing zones and dual sagittal depth designs. After several failed lens orders, corneoscleral profilometry was performed and revealed almost 1100 microns of sagittal height difference between the major scleral meridians (flattest and steepest). A profilometry-guided scleral lens was designed for improved scleral lens alignment, which therein allowed for fit stability, optimized optics, and patient comfort with lens wear. Conclusion Profilometry helps practitioners create customized scleral lenses. Profilometry-guided scleral designs may be an option for patients with high corneal and scleral toricity when other options fail. This case examines the utilization of profilometry in the assessment of corneal and scleral irregularities. Additionally, the role of profilometry-guided scleral lens fitting is reviewed.