PDF(Pubmed)
Abstract：
Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations.
摘要：
巩膜镜片（SL）是大直径的刚性隐形眼镜，是角膜不规则眼睛的主要治疗方法。近年来,人们对SL管理干眼症（DED）的作用越来越感兴趣，许多DED患者报告SL磨损症状缓解。个别病例报告和研究支持了SLs在相关角膜不规则性时对DED管理的作用。这促使从业者开始提倡在DED案例中使用SL，即使没有相关的角膜不规则和其他眼表疾病（OSD）。也有关于在DED的治疗层次结构中可能更早地放置SL的讨论，在TFOSDEWSII报告中，它目前处于更高级的干预水平(步骤3)。这篇评论将介绍目前可用的，尽管稀疏，支持并暗示这种做法的证据，以及辅助证据支持SL磨损在DED中的所谓好处。SL磨损的优点，比如角膜愈合，没有泪液蒸发和隐形眼镜脱水，和改善的视敏度与相关的增加佩戴舒适度，将探讨这将如何使DED患者受益。相反，与DED患者拟合SL相关的挑战，包括增加中午起雾，润湿性差，和患者的主观满意度，还将介绍，以及讨论在这个群体中SL拟合的关键考虑因素。总的来说,虽然需要更多的研究来支持在没有相关角膜不规则和其他形式OSD的DED患者中使用SL，考虑到这些镜片在这些人群中的辅助获益,这些镜片的使用可能被证明具有潜在的更广泛的作用.
