Fenestrated Scleral Lenses: Back to the Origins? Review of Their Benefits and Fitting Techniques.

SIGNIFICANCE: This review illustrates the history of fenestrated scleral lenses, reporting personal communication from one of the present authors; describes their peculiarities and disadvantages; explains the fitting methods so far used; and recommends future fitting methods.Indications and benefits of scleral lenses are widely described in the literature. The introduction of more advanced gas-permeable materials allowed scleral lenses to spread and be available to patients worldwide. Despite the improvement of the gas-permeable scleral lens' clinical performance, complications associated with corneal hypoxia persist, especially in patients with corneal endothelial abnormalities. Fenestrated scleral lenses may solve different complications caused by hypoxia. Also, fenestrated scleral lenses may be beneficial for several issues such as handling difficulties, midday fogging, lens suction, lens instability, conjunctival compression, and alteration of IOP. There is a need and a benefit to directly comparing fenestrated scleral lenses to sealed gas-permeable scleral lenses. This topical review allows practitioners to understand the fenestration philosophy in scleral lenses, practice better, and obtain information on their indications and fitting process. Industry and patients will benefit from future advances in scleral lens designs.