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Scleral Contact Lenses: Past and Future

Twa, Michael D. OD, PhD, FAAO

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doi: 10.1097/OPX.0000000000001556
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While relocating to Houston recently, I came across some artifacts I have collected over the years, and one of those found items was a wide-angle Braff Hapticon diagnostic scleral lens fitting set manufactured by Calcon Laboratories (Fig. 1). What is interesting about this diagnostic fitting set is its connection to the history of scleral lenses (version 1.0).

Wide-angle Hapticon diagnostic lenses.

It turns out that this fitting set was born of the work of a pioneer in scleral contact lens fitting, Dr. Solon Braff. Dr. Braff was a University of California Berkeley Optometry graduate from 1937 who began fitting lenses in the early 1940s. Dr. Braff is a member of the Berkeley Optometry Hall of Fame, and there is a nice historical record of his contributions to the profession told on the University of California Berkeley alumni website:

One of Dr. Braff's contributions to scleral lens fitting was developing techniques with dental alginates to mold the eye without anesthesia, making it possible for optometrists to fit scleral lenses. He went on to define the field for others developing clinical and laboratory techniques, writing, publishing, and educating along the way. His contributions to the optometric literature were invaluable to others who followed.

While scleral contact lenses are not a new idea, they are currently reinvigorating contact lens practice. In 2019, Contact Lens Spectrum reported that the global contact lens market was estimated to be about $9 billion with a 5 to 6% projected growth rate. Scleral contact lenses were estimated to be only 3% of that market. Nevertheless, as you will find in this feature issue, there is a lot of energy in this field and new applications are happening frequently. Nevertheless, there remain some clinical anatomical and physiological challenges to scleral contact lens success, and that is the focus of this feature issue: to shine a light on the open questions, bring new evidence to the field, and stimulate others to help take up the challenge of advancing scleral contact lenses.

What the authors of this feature issue contribute now will help address the many current questions in this clinical area. I thank the lead guest editor, Dr. Andrew Pucker, and our team of guest editors who helped bring this feature issue to life: Dr. Melissa Barnett, Dr. Muriel Schornack, Dr. Langis Michaud, and Editorial Board Member, Dr. James Wollfsohn.

Andrew D. Pucker, OD, PhD, FAAO, FSLS

Dr. Pucker earned his OD, MS, and PhD degrees from The Ohio State University, and he is currently an assistant professor at the University of Alabama at Birmingham. Dr. Pucker has been the principal investigator of a National Eye Institute–funded project related to myopia development, and he currently manages other projects related to refractive error, dry eye, and contact lenses. He is a diplomate of the American Academy of Optometry and a fellow of the Scleral Lens Education Society. He has also received a number of other honors, which include the American Academy of Optometry's Irvin M. and Beatrice Borish Award in 2019.

Dr. Melissa Barnett is a principal optometrist at the University of California, Davis Eye Center. She is an internationally recognized key opinion leader, specializing in dry eye disease and specialty contact lenses. She is a fellow of the American Academy of Optometry and a fellow of the British Contact Lens Association, and she serves on the board of the American Optometric Association's Contact Lens and Cornea Council, the Gas Permeable Lens Institute, and the International Society of Contact Lens Specialists. Dr. Barnett is a past president of The Scleral Lens Education Society. Drs. Melissa Barnett and Lynette Johns authored and edited the book Contemporary Scleral Lenses: Theory and Application with the unique perspectives and contributions of international experts.

Melissa Barnett, OD, FAAO, FSLS, FBCLA

Dr. Langis Michaud graduated from Université de Montréal (OD in 1986, MSc in 1998). Since 2001, he is working there as a full professor; and since 2020, as the dean. He is a diplomate of the American Academy of Optometry and a fellow of the British Contact Lens Association, the Scleral Lens Education Society, and the European Academy of Optometry. He authored more than 90 peer-reviewed articles and has been invited to speak around the world. He is an editorial board member of the Journal of Contact Lens Research and Science.

Langis Michaud, OD, MSc, FAAO, FSLS, FBCLA

Dr. Muriel Schornack received her OD from the Illinois College of Optometry in 1998 and completed a residency in primary eye care at the Illinois Eye Institute in 1999. Upon completion of her residency, she joined the staff of the Mayo Clinic in Rochester, Minnesota, where she is currently a consultant in the department of ophthalmology and an associate professor in the Mayo Clinic College of Medicine. She is a founding member of the Scleral Lens Education Society and the Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) research team. Dr. Schornack remains active in scleral lens–related research activities, with more than 30 peer-reviewed publications.

Muriel Moe Schornack, OD, FAAO, FSLS

Dr. Wolffsohn is a member of the editorial board of Optometry and Vision Science. He holds many distinctions as a leading researcher in contact lenses, myopia, contact lenses, accommodation, refractive technology, and other areas. Dr. Wolffsohn is the associate vice chancellor of Aston University and an experienced educator. He has more than 200 peer-reviewed publications, multiple book chapters, patents, and other contributions to the knowledge base of optometry.

James Wolffsohn, BSc, MCOptom, MBA, PhD, FAAO, FBCLA FRSB, FCOptom

This outstanding team of editors is ideally suited to bring you the latest advances in scleral contact lenses. I hope you will find their effort valuable and inspiring. Scleral lenses will clearly be a growing part of the future of contact lens practice.

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