Predicting scleral GP lens entrapped tear layer oxygen tensions

• It may be difficult to achieve a scleral GP lens/tear system combination to minimize corneal hypoxia.
• Tear layer oxygen tension (pO2) may be the most appropriate metric to assess oxygen availability of scleral GP systems.
• Prescribing high Dk, low corneal vault, and minimal acceptable scleral GP thickness is physiologically beneficial.

Background/PurposeOver the past decade, utilization of scleral gas permeable (GP) contact lenses has steadily increased. Scleral GP lenses offer yet another option for patients suffering from visually debilitating corneal and tear conditions. Oxygen delivery to the cornea in the presence of a contact lens system continues to be a subject of interest, and scleral GP lenses are no exception. This paper utilizes an existing model based on simultaneous two lens systems (piggyback lenses) as a resistance to oxygen in series, and applies this model to scleral GP lens systems.MethodsTheoretical oxygen tensions are calculated for tear layers trapped beneath scleral contact lens systems and the anterior corneal surface with a simple single chamber corneal model using a computer software spreadsheet.ResultsOnly the best case scenario for current scleral gas permeable lenses (thickness and Dk)/tear layer values allow sufficient tear layer oxygen tension (approximately 100 mmHg) to preclude corneal hypoxia.ConclusionsThe results of the spreadsheet model suggest that clinicians would be prudent to prescribe scleral GP lenses manufactured in the highest Dk materials available and to fit without excessive corneal clearance to minimize anterior segment hypoxia.