Dr. Matthew McGee, assistant professor at the Illinois College of Optometry, presented a case at the Global Specialty Lens Symposium on an 18-year-old patient whose life had come to a halt due to limbal stem cell deficiency. By fitting the patient with BostonSight SCLERAL lenses and incorporating back surface venting channels, he was able to rehabilitate the ocular surface, dramatically improve visual acuity, and help the patient return to school, driving, and daily life. Watch the highlights above, or read the full interview below.

Read the full transcript below:

BostonSight SCLERAL: Can you tell us your name and what you do?

Dr. Matthew McGee: I’m Matt McGee. I’m an optometrist at the Illinois College of Optometry as an assistant professor.

BostonSight SCLERAL: Can you tell us a bit about the research that you presented in your poster and why you wished to share it with your colleagues?

Dr. Matthew McGee: The research I presented at GSLS was on a case called “The Limbal Landscape: Restoring Vision and the Ocular Surface with Scleral Lenses.” It was on an 18-year-old patient who presented to our clinic after being referred from a provider they had been seeing for about a year. The patient had limbal stem cell deficiency, and their whole life kind of stopped when they first got this diagnosis. They had to stop their entire life because their vision was so reduced and their eyes were so painful. Scleral lenses helped rehabilitate their ocular surface but also helped them regain a little bit of their independence.

BostonSight SCLERAL: When you say their life stopped, what do you mean by that?

Dr. Matthew McGee: They weren’t able to work, they had to stop school, they weren’t able to drive anymore, and they just weren’t able to function. Their best corrected vision in the right eye was about 20/400, and their best corrected vision in the left eye was counting fingers at about 10 feet.

BostonSight SCLERAL: Talk a bit more about the specific challenge you were dealing with and why you chose to use BostonSight SCLERAL.

Dr. Matthew McGee: I chose to use BostonSight SCLERAL mainly because I reach for it every time I have a complex ocular surface disease patient. BostonSight SCLERAL lenses give you the advantage of using back surface venting channels. For this particular patient with limbal stem cell deficiency, we wanted to reduce any suction, increase tear exchange, and reduce any seal-off because we wanted to minimize any excess damage or trauma to the limbal area — providing the tear exchange, oxygen, and proper fit for it to heal properly.

BostonSight SCLERAL: What customizations or adjustments did you make to get the lens to fit properly?

Dr. Matthew McGee: Because this is an ocular surface disease case, we fit this patient a little bit larger — and I know that’s the calling card for BostonSight. The main thing we did was incorporate those back surface venting channels to provide tear exchange and reduce suction. Besides that, the fit was pretty spot-on.

BostonSight SCLERAL: Can you talk more about how the BostonSight SCLERAL lens addressed the patient’s challenges in terms of comfort, visual acuity, and quality of daily life?

Dr. Matthew McGee: Wearing the BostonSight lens really changed the game for her. When she came in, she was 20/400 in the right eye and counting fingers at 10 feet in the left eye. I like to think of scleral lenses — and specifically our BostonSight lenses — as bigger, better bandage contact lenses for our ocular surface disease patients. It not only improved her acuity, where her final acuity the last time I saw her was 20/60 in the right eye and 20/50 in the left eye, but it also protected her from any trauma from blinking, any trauma from the outside world, and just gave her overall better comfort than a normal basic bandage contact lens.

BostonSight SCLERAL: Has the patient shared anything about improvements in their quality of life since the successful fitting?

Dr. Matthew McGee: Since the successful fitting, the patient has been able to get back into her daily routines. She was able to start school again. The last time I saw her, she was planning to go on vacation — where everything had stopped prior to being fit in a scleral lens. Now she’s able to live a more fulfilled and comfortable life than she was dealing with her limbal stem cell deficiency before being fit into those lenses.

BostonSight SCLERAL: What advice or insights would you have for other practitioners who may be tackling a similar situation like limbal stem cell deficiency?

Dr. Matthew McGee: For other practitioners working with limbal stem cell deficiency patients, sometimes it is a long journey when you are fitting these patients in scleral lenses — and a long journey to recovery. They won’t get better right away most of the time. This is an ongoing journey where you have to deal with inflammation that waxes and wanes, and BostonSight allows for a longer warranty period for you to make those adjustments if that does happen. These patients can also present with persistent epithelial defects that just don’t resolve, and a BostonSight lens with those back surface venting channels — allowing increased tear exchange and increased oxygen — makes for a better environment for that eye to heal compared to some other lenses.

BostonSight SCLERAL: Looking back on this case, how did it reinforce the value of BostonSight SCLERAL within your own practice?

Dr. Matthew McGee: This case reinforced reaching for that BostonSight lens more than any other lens because I know it’s going to work for my ocular surface disease patients. I know I can get that increased tear exchange. I know I can make any adjustments I want with FitConnect. I know it has a long warranty period, and it’s just going to improve the overall environment for that patient. For my ocular surface disease patients, they’re all in a BostonSight lens.

        

About BostonSight^®
BostonSight is a nonprofit eye healthcare organization that advances the treatment of irregular corneas and ocular surface disease through specialty lenses. Our ongoing commitment to research and achieving optimal patient outcomes via innovative specialty lens designs, education, and technology has saved the sight of thousands of people around the world. Learn more at www.bostonsight.org 

Dr. William Skoog, assistant professor at the Illinois College of Optometry, presented a case at the Global Specialty Lens Symposium showing that sometimes the most straightforward approach delivers the biggest impact. By fitting a longtime keratoconus patient with the BostonSight SCLERAL lens and adding front surface eccentricity, he achieved meaningful visual acuity gains without the need for more complex or costly corrective technologies.

Read the full transcript below:

BostonSight SCLERAL: Can you tell us a bit about the research that you presented in your poster and why you wished to share it with your colleagues?

Dr. William Skoog: The case presentation that I presented as a poster at the Global Specialty Lens Symposium this past January was about a patient of mine who is a longtime contact lens wearer, has keratoconus, and has worn various types of scleral lenses in the past but had some difficulties with his vision. What we ended up doing was taking him into a new lens — the BostonSight SCLERAL lens — and using front surface eccentricity to see if we could get any improvement in his vision, since he was always complaining about what he struggled to see. What we found was that even doing something as simple as switching the design and adding front surface eccentricity allowed him to get an improvement in visual acuity. The right eye improved from 20/25 to 20/20, and the left eye improved from 20/60 to 20/40. He was very happy with that improvement.

BostonSight SCLERAL: Can you speak more about the challenge you were addressing? You mentioned this patient had keratoconus. Had they used sclerals before?

Dr. William Skoog: This patient had worn pretty much every type of contact lens that’s been around. He was in soft lenses when he first came to us, and we switched him into corneal GPs, which he failed with. Then we ended up moving him into scleral contact lenses. I believe he was in one, maybe two different lens designs before we moved him into the BostonSight lens.

BostonSight SCLERAL: Why did you decide to use BostonSight SCLERAL for this particular case? What led to that decision?

Dr. William Skoog: This gentleman would every once in a while complain of some vision issues — that he had trouble seeing certain things, whether he was out and about or driving. He just wanted to try and see a little bit sharper. With emerging technologies coming out around how we can utilize scleral lenses to make things even better — whether it’s front surface eccentricity or higher-order aberration-correcting lenses — this patient wanted to try something else to see what we could do. He didn’t have the means to move forward with higher-order aberration-correcting lenses. He was also probably not the best candidate given that he has some extensive scarring in his left eye. So we decided to go the more straightforward route of adding front surface eccentricity, and that option was with the BostonSight SCLERAL lens. That’s how we ended up moving forward with this product.

BostonSight SCLERAL: What specific adjustments or customizations did you make with the BostonSight SCLERAL to make it work for this case?

Dr. William Skoog: With him, there wasn’t a whole lot of adjustments that needed to be made. He was a previous scleral lens wearer, so we knew we could make something successful. In switching him into the BostonSight SCLERAL, it was really just working with the front surface eccentricity to see if adding that would truly improve his visual acuity. We tried different iterations and ended up landing on FSE 1, which got the patient to be the most comfortable with his vision and what he felt was a massive improvement.

BostonSight SCLERAL: In terms of the improvement, is there anything specific the patient noted? Comfort, visual acuity, general quality of life?

Dr. William Skoog: The patient noted that after being in the front surface eccentricity lenses, his vision felt much more comfortable and much sharper compared to his previous contact lenses. He felt much more comfortable not only doing his day-to-day tasks but also driving and things of that nature.

BostonSight SCLERAL: Going back to the customization — did you work with a fitting consultant or did you use FitConnect in this case?

Dr. William Skoog: That is a great question. I believe with him I just used FitConnect. I don’t think I used a fitting consultant, but I could be wrong — it was a while ago.

BostonSight SCLERAL: What insights or advice do you have for other practitioners who might be dealing with the same kind of case — that iterative process of fine-tuning improvements?

Dr. William Skoog: My advice for other practitioners who find themselves in the same spot is this: where we’re at right now with our current scleral lens technology is incredible. We have all these different options and add-ons that we can include with our scleral lenses to get the best outcomes for our patients. However, you might not have access to all that stuff. A lot of these customization options, such as higher-order aberration correcting, require you to have other pieces of equipment. They require more time from you or from the patient, and depending on the patient’s goals, they might not have the ability or the financial means to do that. So although there is a lot of incredible technology out there, don’t forget about the stuff that’s been around for a while and has good literature to back up its uses — that being front surface eccentricity. You don’t always have to go with these very complicated, complex improvements. They do work, but they might not be the right option for the patient you have in front of you. Don’t forget about the more streamlined things that already exist and don’t require additional technology in your office.

BostonSight SCLERAL: Looking back at this whole process and this particular case, how did it reinforce the value of BostonSight SCLERAL within your practice?

Dr. William Skoog: Over the last handful of years, it seems like every one to two years there’s a new hot topic in scleral contact lenses — whether it’s dual sagittal depths to help with centration or higher-order aberration correcting. I think this case reiterated that although there are hot topics and things a lot of people are focusing on, you can’t forget about the existing technology that’s out there. Sometimes the simple option is the better option for the patient. This case reinforced that just switching him into a new lens design with the capabilities of front surface eccentricity helped improve his vision and meet his goals — and it didn’t take that long or too many lens orders, as opposed to some of these other technologies.

BostonSight SCLERAL: Do you remember what diameter you used?

Dr. William Skoog: He was in a 16.5 for the right eye and a 17.0 on the left eye. He’s in the smaller diameter, not the larger.

BostonSight SCLERAL: Thank you so much, Dr. Skoog. We really appreciate you sharing your case and talking about applications with BostonSight SCLERAL.

Dr. William Skoog: Of course. Thanks for the opportunity.

        

About BostonSight^®
BostonSight is a nonprofit eye healthcare organization that advances the treatment of irregular corneas and ocular surface disease through specialty lenses. Our ongoing commitment to research and achieving optimal patient outcomes via innovative specialty lens designs, education, and technology has saved the sight of thousands of people around the world. Learn more at www.bostonsight.org 

Please note that AvKare and Contamac have issued voluntary recalls of the products listed below. Follow the directions for each product to properly dispose of materials.

• AvKare Eye Drops; Read here.
• Nutrifill Lots HFH, HGC, HGI, HGN, HKF, and HKK; Read here: https://contamacsolutions.com/pages/public-notice-recall 

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Lora Castle, NCLE-AC, COA, Director of Consultation and Professional Affairs, shares Beyond the Fit™ offerings at BostonSight SCLERAL, including FitAssist^® and FitSmart™.

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Lora Castle, NCLE-AC, COA, Director of Consultation and Professional Affairs, shares how easy it is to fit sclerals with BostonSight SCLERAL.