Case Report: Novel Patient Training Technique for the Application and Removal of Scleral Lenses

SIGNIFICANCE This report shares a technique that can be used to assist training patients to properly and safely apply and remove prosthetic replacement of the ocular surface ecosystem devices (PD) or scleral lenses to reduce patient training nervousness, limit adverse events from training, and limit training failures. PURPOSE This study aimed to introduce a novel scleral lens application and removal training method. CASE REPORT A 28-year-old woman with limbal stem cell deficiency secondary to contact lens overwear in the left eye greater than the right eye presented for prosthetic replacement of the ocular surface ecosystem treatment. Her ocular history included herpes simplex keratitis, fungal keratitis, and acanthamoeba keratitis in the left eye, which ultimately resulted in corneal perforation requiring repair with cyanoacrylate adhesive. The patient was initially fitted with a PD in 2015 in the left eye but had difficulty with application of the device on the eye, which resulted in discontinuation of use. She returned to the clinic in 2021 for a reevaluation and PD refitting. To address her past difficulties surrounding application and removal of the device, a novel piggyback technique (applying a second scleral lens on top of the primary customized scleral lens that is already on the eye) was used to successfully train the patient. CONCLUSIONS A novel piggyback training technique can be used to overcome obstacles during the scleral lens application and removal training process.