Historical

The first scleral lenses were made in glass, blown and fashioned into shape by craftsmen in the 1880's 1,2,3. These highly commendable pioneering efforts addressed the same clinical indications as we encounter today, but the poor understanding of fitting principles and corneal physiology were limiting factors. Nevertheless, there must have been sufficient realisation of the potential for enhanced vision under adverse conditions to encourage the development of contact lenses as a clinical science.

The manufacturing and clinical processes did indeed improve with the first ground glass preformed fitting sets were coming into use in the 1920's, and eye impression techniques were introduced in the 1930' and 40's. Polymethyl methacrylate (PMMA) was developed at the same time: its thermoplastic properties and the increased potential to be machined allowed more versatility for fitting from impressions and more precise manufacturing processes for preformed fitting. While enhancing the possibilities for scleral lens practice, the introduction of PMMA also brought about the virtually overnight demise of scleral lenses when it became possible to manufacture 'micro lenses' in 1955 4. Thereafter, it was left to a small number of specialised clinics and practices to maintain the clinical and manufacturing skills when necessary.

Scleral lenses were first made in rigid gas permeable (RGP) materials in 1983 5, marking the start of a new era for scleral lens practice. The designs described were traditional fenestrated designs, but the introduction of RGP materials enabled a major shift away from both traditional preformed fitting methods and from impression methods as mainstream scleral lens clinical practice.

Further Reading

FICK AE (1888). A contact lens. (Translation by C. H. May). Archs ophthal; 19, 215 - 226.

KALT E (1888). Reported by PANAS, P. Bull Aced Med, 19, 400, English translation by PEARSON, R.M. Kalt, keratoconus and the contact lens. Am J Optom and Vis Sci; (1989) 66, 643

MULLER A (1889). Brillenglaser und hornhautlinsen. Inurgural Dissertation, University of Kiel; p 20

TOUHY K (1953). Routine procedure for use and application of contact lenses. Opt. J. Rev. Optom; September, p 43.

BIER N (1948). The practice of ventilated contact lenses. Optician; 116, 497-501.

PULLUM KW (1997). Butterworths Hienemann Edited: Phillips and Speedwell. Contact Lenses: A text book for practitioner and student, Chapter 17; 566-608.

EZEKIEL D (1983). Gas permeable haptic lenses. J. Br. Contact Lens Ass; 6(4), 158-161.

BLESHOY H and PULLUM KW (1988). Corneal response to gas permeable impression scleral lenses. J. Br. Contact Lens Ass; 11(2), 31-31

PULLUM KW, HOBLEY AJ and PARKER JH. (1990). Dallos award lecture part two. Hypoxic corneal changes following sealed gas permeable impression scleral lens wear. J Br Contact Lens Assoc; 13(1): 83 - 87.

PULLUM KW, HOBLEY AJ and DAVISON C (1991). 100 + Dk: Does thickness make much difference? J Br Contact Lens Assoc; 6, 158 - 161.

PULLUM KW and STAPLETON FJ (1997). Scleral lens induced corneal swelling: what is the effect of varying Dk and lens thickness? The CLAO Journal; 23(4) 259 - 263.

VISSER R. (1990). Een nieuwe toekomst hoogzuurtofdoorlatende scleralenzen bij verschillende pathologie. Nederlands Tijdschrift voor Optometrie en Contactologie; 3.

SCHEIN OD, ROSENTHAL P, and DUCHARME C (1990). A gas-permeable scleral contact lens for visual rehabilitation. Am J Ophthalmol; 109, 318-322.

KOK JHC, and VISSER R (1992). Treatment of ocular surface disorders and dry eyes with high gas-permeable scleral lenses. Cornea; 11, 518-522.

TAN DTH, PULLUM KW and BUCKLEY RJ (1995). Medical Applications of Scleral Contact Lenses: 2. Gas-Permeable Scleral Contact Lenses. Cornea b; 14(2): 130 - 137.

PULLUM KW and BUCKLEY RJ (1997). A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. Cornea; 16(6) 612-622.

LYONS C J, BUCKLEY R J, PULLUM KW, and SAPP N (1989). Development of the gas-permeable impression-moulded scleral contact lens. A preliminary report. Acta Ophthalmol 1989; 67 (Suppl 192):162-164.

EZEKIEL D (1991). Gas permeable scleral lenses. Spectrum; July 1991, 19 - 24.

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