Managing Pingueculae in Scleral Lens Fitting Using Freeform Design and Precision Vaults
by Dr. Juan Carlos López Méndez, Centro de Atención y Desarrollo Visual
Introduction
Fitting scleral lenses in patients with pingueculae can be challenging because elevated conjunctival lesions may lead to localized lens compression, irritation, or lens decentration. Traditional scleral lens designs often rely on spherical or toric landing zones, which may not adequately accommodate irregular scleral anatomy.
Modern scan-based scleral lens design enables practitioners to create freeform landing zones that closely follow the shape of the ocular surface. However, even when the lens landing zone matches the sclera, localized elevations such as pingueculae may still require additional relief.
The Gaudi Freeform Lens Design App allows clinicians to combine a data-driven freeform landing zone with precision vaults, localized elevations designed to relieve pressure over scleral obstacles.
This case demonstrates how freeform scleral lens design combined with localized precision vaulting can be used to successfully fit a patient with multiple pingueculae.
Ocular Surface Profilometry of an Eye with Two Pingueculae
Figure 1 shows two views of the patient’s right eye obtained with the Gaudi Profilometer using fluorescein linescan mode.
Two prominent pingueculae are present:
Pinguecula (1): temporal location at approximately 9 o’clock, elevated about 200 µm above the best-fit scleral surface.
Pinguecula (2): nasal location at approximately 4 o’clock, elevated about 300 µm above the surrounding sclera.
The elevation values are measured relative to a best-fit spherical reference surface representing the sclera.
Figure 1. (a) Heat map and (b) 3D view of a Gaudi Profilometer scan showing an eye with two pingueculae labeled (1) and (2).
Designing a Freeform Scleral Lens from Profilometry Data
Using the Gaudi Lens Design App, an initial scleral lens design was generated directly from the profilometry scan. Figure 2(a) shows a circumferential cross-section of the lens design at a 15-mm chord.
In the graph, the black line represents the ocular surface, the red line represents the back surface of the scleral lens, and the blue line represents the front surface of the lens. The back surface of the lens is intentionally placed slightly below the ocular surface profile to account for expected scleral lens settling during wear.
Although this freeform landing zone design closely follows the scleral shape and significantly improves comfort compared with conventional lens geometries, additional localized clearance was required over the two pingueculae.
Adding Precision Vaults Over Pingueculae
To provide targeted relief, two precision vaults were added to the lens design:
100 µm vault over pinguecula (1)
130 µm vault over pinguecula (2)
Figure 2(b) shows the resulting circumferential graph after these modifications. The precision vaults introduce localized elevation in the landing zone, allowing the lens to maintain scleral alignment while preventing mechanical interaction with the pingueculae.
Figure 2. Circumferential graphs of the scleral lens showing the sagittal height of the eye and the lens profile at the 15-mm chord. (a) Freeform design without precision vaults and (b) the same freeform design with two precision vaults added at the locations of the two pingueculae.
Clinical Outcome After Lens Dispensing
The final scleral lens incorporated a scan-derived freeform landing zone and two localized precision vaults. Figure 3 shows the clinical appearance of the dispensed lens.
Figure 3(a) demonstrates absence of compression or irritation at the nasal pinguecula. Figure 3(b) shows the fluorescein pattern confirming that the lens maintains a good peripheral seal despite localized vaulting.
Figure 3. Images of a dispensed freeform lens with two additional precision vaults. (a) Nasal pinguecula demonstrating comfortable fit without compression and irritation and (b) fluorescein image showing a good seal despite the additional elevation over the freeform lens surface.
Key Clinical Takeaways
- Pingueculae are common obstacles in scleral lens fitting.
- Profilometry-guided freeform lens design improves scleral alignment.
- Localized precision vaults provide additional relief when scleral elevations are present.
- Combining both approaches allows practitioners to maintain lens stability while minimizing mechanical irritation.
Why Freeform Scleral Lenses with Precision Vaults Improve Comfort
Combining freeform scleral lens landing zones with localized vaulting provides several clinical advantages: accurate scleral alignment, targeted relief of conjunctival elevations, maintained peripheral seal, and reduced mechanical irritation.
This case demonstrates that scan-based scleral lens design with precision vaulting is an effective strategy for fitting patients with multiple pingueculae.