SOFT LENSES HAVE been well studied as drug delivery systems (Rykowska et al, 2021; Yang et al, 2023; Zhao et al, 2023). Advantages of using lenses to deliver topical medication include sustained drug delivery, longer drug retention, and increased bioavailability with minimal side effects (Zhao et al, 2023). Here is what recent literature shows regarding scleral lenses as drug delivery devices.
Cyclosporine: A prospective study by Nakhla and colleagues (2024) examined 9 scleral lens wearers (18 eyes). Participants used preservative-free (PF) cyclosporine 0.05% twice per day (removing and refilling midday) by instilling 1 drop into the scleral reservoir and then filling with PF saline before lens application. At 1 month, there was statistically significant improvement in corneal and conjunctival staining and conjunctival hyperemia. Ocular Surface Disease Index (OSDI) scores improved by an average of 3.83. There was no change in visual acuity, suggesting that sclerals as drug delivery systems for cyclosporine are well tolerated.
Autologous serum tears: Autologous serum tears can be used, either undiluted or diluted with PF saline, to treat graft-versus-host disease by filling the scleral lens with them before application (Harthan and Shorter, 2018). Using serum tears to fill sclerals has also been used to treat persistent epithelial defects (PEDs) secondary to neurotrophic keratopathy (NK) (Frogozo, 2022). The Frogozo study suggested that the healing rate of PEDs using scleral lenses filled with serum was faster than that using serum with soft bandage lenses.
Prophylactic antibiotics: Although scleral lens wear has been used to treat PEDs, there is a risk of microbial keratitis with overnight lens wear of any kind. Ciralsky and coworkers (2015) reported using ventilated scleral lenses to treat PEDs, including overnight wear until re-epithelialization was achieved, followed by the addition of a drop of 0.5% moxifloxacin to the PF reservoir saline as the patients transitioned to daily wear. They retrospectively reviewed 8 eyes following this protocol; all had PED resolution, and none developed microbial keratitis.
Reducing drop frequency: Discontinuation of contact lens wear is usually required in the treatment of fungal keratitis, however, Bian and Jacobs (2024) described resolution of Candida keratitis using compounded amphotericin B instilled in the scleral lens reservoir 6 times per day. This is an alternative to frequent topical drop administration, typically dosed every hour with antifungal agents. After resolution of the fungal keratitis, the patient was prescribed cenegermin 4 times per day (twice into the scleral reservoir), compared to the recommended every 2 hours without scleral wear, to treat a PED.
Anti-VEGF therapy: Yin and Jacobs (2019) reported retrospective results of 13 scleral lens patients with corneal vascularization (NV) of various etiologies, who were prescribed 1 drop of PF compounded 1% bevacizumab (off-label) added to the PF saline used to fill the lens twice per day. Twelve cases showed NV regression and 10 had improved visual acuity with treatment.
Conclusion
Reviews of the literature have found several examples of using scleral lenses as drug delivery systems. By instilling topical ophthalmic drops into the fluid reservoir, sustained drug delivery and longer drug retention is achieved. Of note, all medications added into the lenses should be preservative-free.
References
1. Rykowska I, Nowak I, Nowak R. Soft contact lenses as drug delivery systems: a review. Molecules. 2021 Sep 14;26(18):5577. doi: 10.3390/molecules26185577
2. Yang H, Zhao M, Xing D, et al. Contact lens as an emerging platform for ophthalmic drug delivery: A systematic review. Asian J Pharm Sci. 2023 Sep;18(5):100847. doi: 10.1016/j.ajps.2023.100847
3. Zhao L, Song J, Du Y, Ren C, Guo B, Bi H. Therapeutic applications of contact lens-based drug delivery systems in ophthalmic diseases. Drug Deliv. 2023 Dec;30(1):2219419. doi: 10.1080/10717544.2023.2219419
4. Nakhla MN, Patel R, Crowley E, Li Y, Peiris TB, Brocks D. Utilizing PROSE as a drug delivery device for preservative-free cyclosporine 0.05% for the treatment of dry eye disease: a pilot study. Clin Ophthalmol. 2024 Nov 9;18:3203-3213. doi: 10.2147/OPTH.S487369
5. Harthan JS, Shorter E. Therapeutic uses of scleral contact lenses for ocular surface disease: patient selection and special considerations. Clin Optom (Auckl). 2018 Jul 11;10:65-74. doi: 10.2147/OPTO.S144357
6. Frogozo M. Use of a scleral contact lens to manage a patient with a persistent epithelial defect due to neurotrophic keratitis. Contact Lens Update. 2022 Apr 28. contactlensupdate.com/2022/04/28/use-of-a-scleral-contact-lens-to-manage-a-patient-with-a-persistent-epithelial-defect-due-to-neurotrophic-keratitis
7. Ciralsky JB, Chapman KO, Rosenblatt MI, et al. Treatment of refractory persistent corneal epithelial defects: a standardized approach using continuous wear PROSE therapy. Ocul Immunol Inflamm. 2015;23(3):219-224. doi: 10.3109/09273948.2014.894084
8. Bian Y, Jacobs DS. Drug Delivery in PROSE device as alternative to frequent drop administration in severe ocular surface disease. Eye Contact Lens. 2025;51(4):206-208. doi: 10.1097/ICL.0000000000001163
9. Papathanassiou M, Theodoropoulou S, Analitis A, Tzonou A, Theodossiadis PG. Vascular endothelial growth factor inhibitors for treatment of corneal neovascularization: a meta-analysis. Cornea. 2013 Apr;32(4):435-44. doi: 10.1097/ICO.0b013e3182542613
10. Yin J, Jacobs DS. Long-term outcome of using Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) as a drug delivery system for bevacizumab in the treatment of corneal neovascularization. Ocul Surf. 2019 Jan;17(1):134-141. doi: 10.1016/j.jtos.2018.11.008