Scleral Lens Issues and Complications; Their Recognition, Etiology, and ManagementDaddiFadelDundas, Ontario, Canada: Dougmar Publishing Group, Inc.; 2020. $99.00

Scleral Lens Issues and Complications; Their Recognition, Etiology, and Management. Fadel D. Dundas, Ontario, Canada: Dougmar Publishing Group, Inc.; 2020. $99.00.Contact Lens Spectrum's 2020 GP Annual Report states, “…scleral lens use continues to increase and may soon rival corneal lenses as the primary GP design prescribed….” With the dramatic increase in utilization of gas-permeable scleral contact lenses over the last few years comes an ongoing mandate for distribution of clinical knowledge. To this end, Fadel states in the preface that she intends to transmit her passion, dedication, and devotion for scleral lenses with the goal of helping practitioners bring their benefits to patients and “change lives.” She divides clinical scleral lens problems into “issues” that do not lead to persistent tissue morbidity and “complications” that may damage vision. The author is clearly a European leader in this field, exemplified by her credentials and publications. On the positive side, the illustrations are appropriate, copious, and compelling. The text and tables are clinically based and thorough and offer the scleral lens fitter—either novice or those with experience—a differential etiology, diagnoses, and management outline for each problem the clinician might encounter. I found the embedded hyperlinked videos compelling and innovative. Daddi Fadel's text is clearly a contribution to the literature in this area of contact lens practice. Unfortunately, the text is not always smooth and is occasionally unclear. Extensive tables and outlines have been used instead of text; some may find this beneficial, while others less so. There is little discussion of any issue or complication in depth. There is also little in the way of guidance on distinguishing between the various differential diagnoses and management options presented for each problem. After chapter 2, references do not follow each chapter but are instead inserted at the end of each subsection inside chapters. References are not annotated in the text but offered as background to the reader should they care to further investigate the discussed topic. This may be advantageous to some but falls short of evidence-based medicine guidelines and expectations. Unfortunately, complication management in this text is incomplete for the 2020 North American OD; neither referral nor medical treatment protocols are noted, with perhaps rare exception (e.g., treatment of dry eye and ocular surface disease). Notably, the text lacks the current management of serious complications such as microbial keratitis and corneal infiltrates. Although preventive and contact lens measures are detailed in expansive tables and in outlines and discussion, appropriate referral, antibiotics, and/or steroids to treat suspected or confirmed active corneal infection are lacking. Moreover, the impact of systemic blood pressure and/or prior steroid use as potential etiologies of intracorneal or subconjunctival hemorrhage is excluded. I suspect such medical management lies outside the author's European training and practice scope, but it is an omission for those whose practice includes medical optometry. This text is a labor of love for the author, who organizes and shares with her readers her own “state of the art” modern scleral lens practice. In that regard, she is successful and should be lauded. Nevertheless, clinicians practicing with expanded optometric scope that includes medical management may need to go beyond this text for guidance on contemporary diagnostic, treatment, and management protocols for scleral lens complications. Barry A. Weissman, OD, PhD, FAAO (Dip CCLRS) Southern California College of Optometry at Marshall B. Ketchum University Fullerton, California Stein Eye Institute David Geffen School of Medicine University of California, Los Angeles Los Angeles, California [email protected]

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