Scleral Lenses Plus PRGFs Reduce Refractory Ocular Surface Disease Symptoms

Mini-scleral contact lens
Contact lens designs are classified as scleral lenses when there is full bearing on the sclera, further distinctions of the scleral lens group include mini-scleral and large-scleral lenses. These distinctions emphasize differences in central corneal clearance and other fitting characteristics. A lens that is 6mm larger than the visible iris diameter is classified as a mini-scleral lens.
A subjective survey shows high patient satisfaction with the approach.

Treating dry eye patients with a combination of scleral lenses and plasma rich in growth factor (PRGF) eye drops can provide a safe therapeutic option to manage patients with complex ocular surface disease recalcitrant to other treatments, according to a retrospective cohort study published in The Ocular Surface. The combined approach significantly decreases refractory symptoms, the study shows.

Dry eye patients have no shortage of therapeutic options, but with many of them, patients run the risk of merely suppressing symptoms, while continuing to experience irritation and potentially progressing to sight-threatening corneal disease. 

To review the safety and efficacy of combined PRGF drops and scleral lens therapy in patients with ocular surface disease, researchers reviewed the cases of 26 patients of various etiologies. Patients were screened for at least 3 months of concurrent treatment with PRGF and SCL. The team collected retrospective pre- and post-treatment measurements, including patient satisfaction, severity and frequency of dry eye symptoms measured by a modified Symptom Assessment in Dry Eye (SANDE) questionnaire, visual acuity, and the number of concurrent treatments.

The SANDE scores shows significant subjective improvements including a reduction of irritation symptoms, and in the frequency and severity of ocular irritation. Of the patients who did not experience these subjective improvements, 1 had persistent corneal epithelial defect that healed on the combined therapy, and 2 had corneal haze, both of which improved. Visual acuity significantly improved for all patients with corneal haze, but researchers did not note significant acuity improvements overall. 

“The combined therapy was found to be safe with no reported side effects and no minor or major adverse events, particularly infection. All patients, including the 7 being treated for persistent epithelial defects, did not have any infection concerns,” according to the researchers. “This is significant given that ocular surface disease is a well-documented predisposing factor to microbial keratitis and there are concerns of contaminated autologous serum eye drops.”

Investigators note several limitations to their work, including its small sample size, that the retrospective and qualitative questionnaire is subject to recall and sampling error, the lack of a control group, and that time periods to observe improvement in epithelial defects, corneal sensation, and haze could not be accurately determined.

Disclosure: One of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wang M, Yennam S, McMillin J, et al. Combined therapy of ocular surface disease with plasma rich in growth factors and scleral contact lenses. Ocul Surf. Published online September 17, 2021. doi:10.1016/j.jtos.2021.09.003