Knowledge Base
2. Linking EyeSpace to your topographer

1. How to troubleshoot EyeSpace Scleral lenses

11. Scleral TroubleshootingCharl Laas

You can download and use the EyeSpace Scleral troubleshoot form for your record cards and the troubleshooting process. For more information on fitting the EyeSpace Scleral lenses read the EyeSpace Scleral 2 Quick Start Guide and then follow the Scleral fit and troubleshoot checklist below to complete the attached EyeSpace Scleral troubleshoot form:

Step 1 - Insertion

Insert the EyeSpace scleral lens with saline and a small amount of fluorescein and allow the lens to settle for 15 to 20 minutes.

Step 2 - Slit lamp

Use the slit lamp with a diffuse white and cobalt blue light to observe the following:

Scleral landing zone circle

Note any blanching: Limbal (LB), Conjunctival (CB), Meridional (MB). Look for Limbal congestion (Con), Conjunctival prolapse (CP), Neovascularization (NV), and ensure proper limbal clearance (LC).

If present measure and mark the engraved flat axis position (0 - 180 degrees) in the topography over lens section.

Neg NaFL staining circle

Indicate the fluorescein inflow or flush under the lens: Note the position, tempo (quick or slow), volume (small or large) and effort (nudge or no dodge).

Step 3 - Post Lens Tear Thickness (PLTT)

Observe the PLTT with a slit lamp optic section set at 45 degrees or OCT:Record the nine PLTT points under the BOZD and for more accurate troubleshooting also complete the PLTT points on the scleral limbal zone as indicated by the attached scleral form.

Using the slit lamp optic section clinically judge the Back Optic Zone Radius. A positive tear profile indicates a BOZR too steep, a negative tear profile indicates a BOZR too flat.

Step 4 - Over Topography

Take multiple topographies over the geometric center of the EyeSpace Scleral lens on the eye and remove any out shooter maps. Record the average Delta K and Flat K axis. Mark the axis direction on the circle provided (include the value in degrees).

Step 5 - Over-Refraction

Measure and record the uncorrected VA with the lens on the eye. Record the over-refraction using a trial frame and remember to compensate for vertex distances for powers over ± 4.00D. Record the best-corrected VA.

Step 6 - Notes

Add any notes clinically relevant to the fit and/or troubleshoot process.

Step 7 - Suggestions

Look at all the recorded observations and calculate your final lens (preferably use the EyeSpace Scleral fitting module). If you are uncertain what to order place your calculated lens parameters in the suggestion section. This will help your troubleshooter to see your insight and help guide you with the fit.

Step 8 - Support

Please send your Oculus .U12 or Medmont .mxf export topography files with your Scleral Troubleshoot Form to your support desk.Please ensure to complete all the information on the page. Failure to do so will lead to delays or inability to provide accurate troubleshooting advice.

Troubleshoot Examples

Too little Sagittal Toricity

Too much Sagittal Toricity

BOZR too flat