Corneal Nerve Structure and Function After Long-Term Wear of Fluid-Filled Scleral Lens

Purpose: The aim of this study was to determine whether long-term wear of a fluid-filled scleral lens alters basal tear production, corneal sensation, corneal nerve density, and corneal nerve morphology in 2 disease categories. Methods: Patients recruited from the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment program at the Weill Cornell Medical College were categorized into 2 groups: distorted corneas (DC) or ocular surface disease (OSD). We measured tear production, central corneal sensation, subbasal nerve density and tortuosity, and stromal nerve thickness before and after long-term wear of the prosthetic device used in PROSE treatment, defined as at least 60 days of wear for a minimum of 8 hours a day. Results: Twenty patients were included in the study. After long-term wear of the prosthetic device, tear production decreased in patients with DC (21.2 +/- 8.5 to 10.4 +/- 4.6 mm; P < 0.0001) but did not change in patients with OSD (7.5 +/- 5.2 to 8.7 +/- 7.2 mm; P = 0.71). Corneal sensation increased in the DC group (45.6 +/- 9.2 to 55.0 +/- 5.6 mm; P < 0.05). There was no significant change in sensation in patients with OSD (45.0 +/- 8.7 to 49.1 +/- 14.8 mm; P = 0.37). Subbasal nerve density, subbasal nerve tortuosity, and stromal nerve thickness remained unchanged in both DC and OSD groups after long-term wear (P > 0.05). Conclusions: Patients with DC had significantly reduced basal tear production and increased corneal sensation after long-term wear of the scleral lens, but patients with OSD did not show any changes in tear production or corneal sensation.