To describe the use of Jupiter scleral lenses (Medlens Innovations, Front Royal, VA; and Essilor Contact Lenses, Inc., Dallas, TX) in the management of keratoconus. We performed a single-center retrospective chart review of our initial 32 patients with keratoconus evaluated for scleral lens wear. All patients were referred for scleral lens evaluation after exhausting other nonsurgical options for visual correction. Diagnostic lenses were used in the initial fitting process. If adequate fit could not be achieved with standard lenses, custom lenses were designed in consultation with the manufacturers' specialists. The following measures were evaluated for each patient: ability to tolerate and handle lenses, visual acuity with scleral lenses, number of lenses, and visits needed to complete the fitting process. Fifty-two eyes of 32 patients were evaluated for scleral lens wear. Of these, 12 patients (20 eyes) decided not to pursue scleral lens wear after initial evaluation. One patient (2 eyes) abandoned the fitting process after cataract surgery. The remaining 19 patients (30 eyes) were fit successfully. The average number of lenses ordered per eye was 1.5. The fitting process required an average of 2.8 visits. Standard lenses were prescribed for 23 eyes, and custom designs were needed for 7 eyes. Median best-corrected visual acuity improved from 20/40 (mean, 20/76) before scleral lens fitting to 20/20 (mean, 20/30) after fitting. Follow-up ranged from 3 to 32 months. Jupiter scleral lenses provide acceptable visual acuity and comfort in patients with keratoconus. The availability of diagnostic lenses facilitates the fitting process.

Objectives. To describe the use of the Jupiter scleral contact lens (Medlens Innovations, Front Royal, VA or Essilor Contact Lens, Inc., Dallas, TX) in the management of ocular manifestations of chronic graft versus host disease (cGVHD). Methods. This study is a retrospective case series. Five consecutive patients with severe keratoconjunctivitis sicca (KCS) associated with cGVHD that could not be adequately managed with conventional therapy were evaluated for scleral contact lens wear between January and December 2007. All patients were evaluated with lenses from the standard 18.2 mm Jupiter B diagnostic fitting set. If lenses of standard design failed to provide adequate fit, custom lenses were designed. Three outcome measures were evaluated: the patient’s ability to tolerate and successfully handle the lenses, improvement in symptoms of KCS, and improvement in visual acuity. Results. All 5 patients (10 eyes) were successfully fit with Jupiter scleral lenses. Six eyes of 3 patients were successfully fit with lenses of standard design. Standard parameters were altered to achieve adequate fit in 4 eyes of 2 patients. All patients reported subjective improvements in comfort with Jupiter scleral lenses, and best-corrected vision improved in 7 of the 10 eyes fit within the first several months of contact lens wear. The remaining 3 eyes maintained the visual acuity measured before scleral lens wear (20/20 in 2 eyes, 20/40 in 1 eye). Duration of follow-up ranged from 4 to 14 months. Conclusions. Jupiter scleral lenses can relieve symptoms of KCS and may improve vision in patients with cGVHD.

Objectives: To determine whether parameters of anterior corneal contour as identified by topographic analysis (steep and flat simulated keratometry, reference sphere) predict the base curve of Jupiter scleral lenses in patients with dry eye syndrome and keratoconus. Methods: We identified 33 eyes with dry eye syndrome and 21 eyes with keratoconus that were fit with Jupiter scleral lenses of standard design between June 2006 and July 2009. Steep and flat simulated keratometry powers and shape factor from axial topographic maps, reference sphere from elevation maps, and base curve of the scleral lens prescribed for each eye were recorded. Correlations between topographic indices and base curve were evaluated by using the Pearson correlation coefficient, and significances were completed by using generalized estimating equation models. Results: In dry eye syndrome, the base curve of the final scleral lens prescribed correlated with the steep keratometric power (r = 0.70, P = 0.05, n = 33), the flat keratometric power (r = 0.71, P<0.001, n = 33), and the reference sphere (r = 0.73, P = 0.002, n = 33). In eyes with keratoconus, base curve also correlated with the steep keratometric power (r = 0.72, P<0.001, n = 19), the flat keratometric power (r = 0.70, P<0.001, n = 19), and the reference sphere (r = 0.68, P<0.001, n = 21). There were no correlations between base curve and shape factor. Conclusions: In eyes with normal and abnormal ocular contour, base curve of scleral lenses correlates with reference sphere and steep and flat keratometric powers, but the predictive relationship is weak (r² ∼0.50). Diagnostic fitting may be the most efficient method of fitting scleral lenses at present.