Practitioner Interview: How Front Surface Eccentricity Improved Vision for a Keratoconus Patient
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
