The first Scleral Lenses were made in glass, blown and fashioned into shape by craftsmen in the 1880's (see references 1, 2 and 3). These highly commendable pioneering efforts addressed the same clinical indications as we encounter today, but the poor understanding of fitting principles and corneal physiology were limiting factors. Nevertheless, there must have been sufficient realisation of the potential for enhanced vision under adverse conditions to encourage the development of contact lenses as a clinical science.
The manufacturing and clinical processes did indeed improve with the first ground glass preformed fitting sets coming into use in the 1920's, and eye impression techniques introduced in the 1930' and 40's. Polymethyl methacrylate (PMMA) was developed at the same time: its thermoplastic properties and the increased potential to be machined allowed more versatility for fitting from impressions and more precise manufacturing processes for preformed fitting. While enhancing the possibilities for Scleral lens practice, the introduction of PMMA also brought about the virtually overnight demise of scleral lenses when it became possible to manufacture 'micro lenses' in 1953 (see reference 4). Thereafter, it was left to a small number of specialised clinics and practices to maintain the clinical and manufacturing skills when necessary.
Scleral lenses were first made in rigid gas permeable (RGP) materials in 1983 (see reference 5), marking the start of a new era for scleral lens practice. The designs described were traditional fenestrated designs, but the introduction of RGP materials enabled a major shift away from both traditional preformed fitting methods and from impression methods as mainstream scleral lens clinical practice.
1. FICK AE (1888). A contact lens. (Translation by C. H. May). Archs ophthal. 19, 215 - 226.
2. KALT E Reported by PANAS, P. Bull Aced Med, 19, 400, (1888). English translation by PEARSON, R.M. Kalt, Keratoconus and the contact lens. Am J Optom and Vis Sci, (1989) 66, 643
3. MULLER A (1889). Brillenglaser und hornhautlinsen. Inurgural Dissertation, University of Kiel, p 20.
4. TOUHY K (1953). Routine procedure for use and application of contact lenses. Opt. J. Rev. Optom; September, p 43.
5. EZEKIEL D (1983). Gas permeable haptic lenses. J. Br. Contact Lens Ass. 6(4), 158-161.