HAPTIC (SCLERAL) CONTACT LENSES

Gerald E. Lowther, O.D., Ph.D.

USES:

Cosmetic shells
Distorted corneas
Keratoconus, Pellucids
Surface disease
Lid deformatories
Decentered pupils
Water sports
 TYPES OF HAPTIC LENSES

Preformed
-set parameters
-usually lathe cut

Molded

-made from an impression of the eye

 MOLDING PROCEDURE

SUPPLIES:

-Impression material-Moldite made from alginate

(a product of sea kelp used in dental work)
-rubber mixing bowl
-spatula
-molding shells
-sterile, distilled water (not saline)
-anesthetic
-Band-aids
-irrigating solution
-fluorescein
(materials available from prosthetic eye
companies as AO Monoplex Division)
 POSITIONING AND EDUCATING PATIENT

Position patient in supine position-lay patient back in chair

Determine fixation point-cover eye to be molded and position
eye with slight nasal fixation
(medial rectus flattens
cornea)
Dry lower lid and place tape on lid
-helps pull lid from under shell
Explain procedure to patient
-where to look, etc.
May want to insert shell if patient
is apprehensive
 IMPRESSION SHELLS

Use as large a shell that can be easily inserted

Shells must have apertures so mold material will

adhere to shell and not stay on the eye on removal

Shells may have hollow handle so impression material can be

injected through handle.

There is a mark on the shell

indicating the temporal
position
-must position at outer
canthus
 MOLDING THE EYE
Mix distilled water with molding material in
rubber bowl
-spatulate, do not beat and create
bubbles
Mix to a thick, whipped cream
consistency
Compound comes premeasured with
a mark on vial for amount of
water

INSERTION TECHNIQUE

-spatulate molding material

into shell filling it
TAKING THE IMPRESSION-INSERTION TECHNIQUE

With shell filled, have patient look down as far as they can
Lift upper lid up and away from the eye
Insert the shell and material under upper lid
-it helps to slightly rotate the shell as you put it in
Be sure to hold shell up away from the cornea (against back
of lid)
While holding shell handle, have patient look up
With patient looking up, pull the lower lid out from under
the shell using the tape as a handle.
Next have patient look at fixation point
Material will set up in 1-2 minutes after mixing water with it
-plenty of time to insert it but can not waste time
When excess material on lid does not stick to finger on touch
it is ready to remove.
Pulling lower lid out from
under shell.

If patient has a high Rx

have them hold lens in
front on other eye to hold
fixation.
 IMPRESSION TECHNIQUE

Place molding shell in eye with temporal mark in proper

position

Hold shell away from cornea-have assistant hold shell

Fill syringe with the molding material

Inject molding material through handle of shell

-use minimium amount of pressure required

Inject enough material that it comes out onto lids

This technique can cause some corneal distortion giving a

less accurate impression
 REMOVING THE SHELL AND IMPRESSION

When material set, remove excess from the lids and top
of shell

Loosen lids from impression material

Have patient look up, while holding handle use the lower
lid to break suction under lower edge of impression

With lower lid under mold, remove impression

-if necessary have patient look down once lower lid
is under the impression.
 REMOVING THE SHELL AND IMPRESSION
Once impression is out of the eye place it in a cup of water
or wrap it in a wet towel to prevent it from drying
Irrigate any excess molding material left in the cul-de-sac
Remove excess material from lids with a wet tissue
Inspect the eye with fluorescein and the biomicroscope
-will usually have some corneal stippling
 POSSIBLE PROBLEMS DURING MOLDING

Patient has a blepharospasm and you do not get shell

all the way in.
-in this case leave shell and material in place until
the material sets up-then remove
(if you try to remove it prior to it setting up you
will have a lot of material to swab out of the
cul-de-sac)

Discomfort during molding:

-you are pressing the edge of the shell against the

upper conjunctiva.

Should not be painful-in fact can do it without anesth

 MAKING THE EYE MODEL

A dental stone model of the eye is next made.

Dental stone comes as a powder and is mixed with water

to a consistency of toothpaste.

Impression is removed from water and surface water blotted off.

Dental stone is put into the impression

-should vibrate or tap impression to be sure it
is completely filled without bubbles.

Impression shell with impression and dental stone is allowed

to sit and harden.
-can handle in an hour but not fully hardened for
24 hours.
 Dental stone in envelope,
rubber bowl, vibrator.

Dental stone eye model

 COPYING THE EYE MODEL

A copy of the eye model can be made in case the original is

broken in the process of making the lens.

Clay dam made around the eye model, model is coated with a
releasing agent and more dental stone poured onto the model.

Eye model with Negative of

clay dam. eye model
 COPYING THE EYE MODEL

Silicone impression material can be used to make a copy. It is

mixed and placed into a cup or holder. The eye model is placed
in the soft material. The material will set and be a solid rubber
material.

Dental silicone modeling material. Silicone negative.

 OBTAINING THE PROPER CLEARANCES

Final lens must have clearance over the cornea and limbus.
If lens rests on cornea or limbus it will be uncomfortable.

Need about 0.20 mm corneal clearance. Haptic needs to be

flatter than sclera or it will fit too tight. Use thin plastic shims
(0.10 mm thick) to achieve this.
 OBTAINING THE PROPER CLEARANCES

With no shims there would be Need clearance over whole

no clearance over the cornea cornea and limbus.
and the lens would adhere.
 OBTAINING THE PROPER CLEARANCES

Corneal shim is 0.2 mm thick, haptic shim 0.10 mm.

Can use plastic sheets obtainable from a hardware.

Eye model model with model with corneal

corneal shim and haptic shims
 FORMING THE SHIMS

Shim material put on PMMA plastic sheet with grease in

between and heated until pliable. Then pressed over the
eye model. The corneal shim is then cut out using a razor blade.
Other types of presses that can be used.
 FORMING THE SHIMS

The procedure is repeated with a thinner piece of shim

material for the scleral shim. A 1.0 mm piece of plastic is used
on top of the thin material. This thicker portion will become
the lens.

Heating the plastic

 REMOVING EXCESS PLASTIC AND SHAPING LENS

Excess plastic is ground off using grinder or hand held

Dremel type tools. Can not cut the plastic off as it will crack.
 REMOVING EXCESS PLASTIC AND SHAPING LENS

A coarse file is used to further finish the lens. Once the general
shape is reached, the bottom is filed flat in order to eventually
achieve a uniform edge.
 EDGING THE LENS

Shape the edge with a file and then remove file marks with a
fine emery paper.
 EDGING THE LENS

Once shaped the edge needs to be polished. A rag buff or

just a sponge tool as used to edge RGP lenses can be used.
With the edge finished, the lens can be put on the eye to
determine the fit and where to place the fenestration
(aperture). The fenestration allows flow of tears under lens
and releases suction.

Using a permanent ink, felt pen mark a spot over the pooling at
the temporal limbus just below the upper lid for the fenestration.
This position makes the fenestration relatively unnoticeable.
FENESTRATING THE LENS

1. Drilling fenestration
with 1 mm hand-
held drill bit.

3. Polishing the fenestration

with a felt-tipped cone
using CL polish.

2. Beveling the
fenestration opening
 DETERMING BACK OPTIC RADIUS
Back radius should be about 0.3 mm flatter than cornea. Can
determine by coating back surface with ink and then touching
the lens down on polishing lap, changing laps until it matches
the back surface.

Lap too flat Lap too steep

Lap on know radius
 FINISHING BACK OPTIC
Once the radius is determined, the back surface is roughed in
using a diamond lap with water or tape lap with a grit such as
Pumice or a compound used to rough surface spectacle lenses.
It is then polished with contact lens polish on tape or on a wax
tool. Double rotation technique as when doing peripheries of
RGP lenses should be used.
 DETERMING THE FIT OF THE LENS

At this point the lens can be put on the eye and the fit evaluated.
There should be clearance over the cornea and limbus usually
with a small bubble over the temporal limbus.

The lens will settle

some with time so
extra clearance initially
is desirable. This lens
shows a slightly larger
bubble then is finally
desired after settling.
 DETERMING THE FIT OF THE LENS

After additional central grind-out

Lens with central touch of back optic giving more clearance
 DETERMING THE FIT OF THE LENS

Corneal shim diameter too small,

need more limbal clearance.

Can use abrasive point

to grind out plastic in
localized area.

Polish with a felt

cone or small
polishing pad
using CL polish
 DETERMING THE FIT OF THE LENS

Excessive large, inferior bubble. Need to grind out haptic

peripheral to the bubble to allow lens to settle back and
decrease the bubble size.
 DETERMING THE FIT OF THE LENS

Too much central clearance with touch at limbus in horizontal

meridian (large amount of WTR). Need to increase limbal
clearance in horizontal meridian which will allow lens to
settle back and decrease the central clearance.
 DETERMING LENS POWER

Use of a RGP diagnostic lens example:

A 7.50 mm BCR, -3.00 D. lens is on the eye

Over-refraction: -2.00 D.

Haptic Lens BCR: 7.80 mm

Power in haptic lens: -5.00 (RGP + OR) + -1.75 D (from
BCR change from 7.5 to 7.8 mm) = -3.25 D. required.
Lens is mounted on a lathe
and the front radius is cut.
The front surface is then
polished as is done with RGP’s.
Most RGP labs can do this.
After the front optic is cut there will be a ledge at the edge of
where they cut. This needs to be smoothed off with a razor
blade and then polished in this area with polish.
 PERFORMED HAPTIC LENSES

ADVANTAGES:

-molding not required

-obtainable from a laboratory
-easily reproduced
-can specific all the parameters

DISADVANTAGES:

-may not be able to fit a distorted eye or high toricity

Preformed haptic lenses usually have a central optic, several
peripheral curves to obtain peripheral corneal and limbal
clearance with a haptic radius.

The lens may not be round but oval with largest section
going temporal. Different optic and haptic radii are
available.
PERFORMED HAPTIC LENSES

Determine the haptic radius

first using lenses that clear
the cornea and limbus.
Want a close match between
haptic and sclera.

A. Haptic radius too

steep.

B. Haptic radius too

flat.
 To determine haptic fit apply slight pressure to the lens and
look for the blanching of the vessels.

Blanching of vessels at junction Blanching at the edge of the

indicating a flat haptic radius lens indicating a steep haptic
 PERFORMED HAPTIC LENSES

Once the haptic radius is determined, use diagnostic lenses

with different central radii to obtain central and limbal
clearance. Fit should look the same as described for the
molded lenses.
 PERFORMED HAPTIC LENSES

POWER DETERMINATION:

Determine the power required by refracting over a diagnostic

lens and make any compensation required for base curve
changes and add over-refraction.

If diagnostic lenses do not have finished optics you can

determine the power required as described for molded
lenses using RGP diagnostic lenses and compensating
for and base curve change.

Order lens from laboratory giving all parameters.

 PERFORMED HAPTIC LENSES

LENS MATERIAL:

Up until recent years PMMA was the only material

Today fluorosilicone/acrylate ploymers are used.

-most can only be only be lathed because they are
thermosetting plastics.

Availability:
Boston Foundation for Sight: http://www.bostonsight.org/
 PERFORMED HAPTIC LENSES

Boston Scleral Lens:

Fluorosilicone/acrylate: Dk 127
c.t. 0.25-0.39
15-23 mm diameter

With lenses of Dk over 115 and ct 0.30 mm the

corneal swelling is usually less than 4%

(CLAO J 23:259-263, 1997)

Preformed lenses can be modified as described for molded
lenses using grinding and polishing tools.