Contents lists available at ScienceDirect Contact Lens and Anterior Eye journal homepage: www.elsevier.com/locate/clae Assessment of a practitioner’s perception of scleral contact lens complications Andrew D. Pucker a, ⁎ , Katherine M. Bickle b , Lisa A. Jones-Jordan b , Anita Ticak c , Justin T. Kwan d , Jamie Kuhn e , Jessica Mathew f , Carolina M.E. Kunnen c a University of Alabama at Birmingham, School of Optometry, United States b The Ohio State University, College of Optometry, United States c University of Houston, College of Optometry, United States d Marshall B. Ketchum University, College of Optometry, United States e Midwestern University, Arizona College of Optometry, United States f Alcon Laboratories, United States ARTICLE INFO Keywords: Scleral Lens Midday fogging Complications Survey Fitting ABSTRACT Purpose: The purpose of this survey was to better understand scleral lens (SL) practitioners’ fitting preferences and minor SL complications and their subsequent treatments. Method: Practitioners who attended the 2017 Global Specialty Lens Symposium were asked to complete an electronic questionnaire that was created by the investigators, a survey that asked practitioners about their SL fitting experience and preferences, their patients’ experience with poor SL wetting, SL fogging, ocular symptoms (redness, pain/discomfort, dryness), and blurred central and side vision, and how the practitioners treated these conditions. Results: This study analyzed data from 164 SL practitioners. The practitioners had been in practice for 16.3 ± 13.4 years, had been fitting SL for 5.5 ± 5.0 years, and fit 7.4 ± 7.1 SL/month. Practitioners preferred a SL with a final central corneal clearance of ∼200 μm and an overall diameter between 15.1 mm to 16.5 mm. Poor SL wetting (90.8% of practitioners documented condition), SL fogging (84.8%), blurred central vision (40.2%), ocular redness (34.8%), ocular dryness (24.4%), ocular pain/discomfort (20.7%), and blurred side vision (12.8%) were encountered by the practitioners. Practitioners preferred treating poor wetting and fogging with lens removal, cleaning, and reapplication, blurred central vision with a lens power change, blurred side (peripheral) vision, ocular redness, and ocular pain with a lens parameter change, and dryness with artificial tears. Conclusions: Most SL practitioners preferred a SL central corneal clearance of ∼200 μm, and they occasionally encountered SL-related complications in their practice, which they treated similarly to corneal gas permeable CLs. 1. Introduction With the advent of utilizing highly gas permeable materials in scleral lenses (SL) and improvement in SL designs, SL fitting has in- creased over the past few years for patients who have corneal irregu- larities, ocular surface disease, and ametropia [1–6]. While it is true that SL are prescribed for uncomplicated ocular conditions, they are most frequently prescribed to patients who have advanced corneal ir- regularities because SLs provide a hard refractive surface with an un- derlying reservoir of tears and preservative free saline solution, which is able to mask corneal irregularity [1]. This masking often dramatically improve a patient’s visual experience, even in situations where soft and corneal gas permeable contact lenses (CL) have failed because of factors such as poor lens stability or comfort, while at the same time allowing the eye to be more hydrated and often more comfortable compared to other modalities [2,5,7,8]. The success and generally accepted safety of SLs in challenging and uncomplicated cases have created a renewed interest in this long- standing CL modality [2,6]. Nevertheless, there is a paucity of in- formation related to even the most basic aspects considered by the everyday SL practitioner. One facet is related to SL fitting trends. A SL practitioner typically considers five lens parameters when fitting a SL: https://doi.org/10.1016/j.clae.2018.11.003 Received 18 July 2018; Received in revised form 1 November 2018; Accepted 5 November 2018 ⁎ Corresponding author at: University of Alabama at Birmingham, School of Optometry, 1716 University Blvd Birmingham, AL 35233, United States. E-mail address: apucker@uab.edu (A.D. Pucker). Contact Lens and Anterior Eye 42 (2019) 15–19 1367-0484/ © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. T