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Chapter Summaries

The introduction has the aim to present the topics discussed in the following chapters, to provide clarification and a definition of issues and complications, and to expose the objectives of the manuscript. 

Chapter 1: Vital Stain In Scleral lens Practice 
The use of vital stains, also referred to as dyes, in scleral lens practice, is essential to assess corneal and conjunctival health and the fitting relationship of the lens with the underlying ocular surface. The dyes used are sodium fluorescein and lissamine green. Description of the benefits and limits of both dyes is provided.

Chapter 2: Scleral Shape Assessment Using Slit Lamp and Diagnostic Scleral Lenses 
This chapter contains a definition and a classification of the corneoscleral shape and offers the procedures for the assessment of scleral profile, using a slit lamp and diagnostic scleral lenses, and the guidelines in selecting a scleral lens design.

Chapter 3: Issues 
Description, observation, symptoms, clinical signs, etiology, and management of each clinical signs and issue that may be observed during scleral lens fitting are discussed in this chapter.

Chapter 4: Complications 
Description, observation, symptoms, clinical signs, etiology, and management of each complication related to scleral lens fitting are discussed in this chapter.

Chapter 5: Subdivision of Issues and Complication Based on Two Factors: Non-Optimal Fitting Relationship and Handling, Care and Compliance 
Scleral lens issues and complications may be due to a non-optimal lens fitting and to scleral lens handling, care, and compliance. Chapters 5 has the aim to subdivide and summarize the issues and complications based on two main factors, non-optimal fitting relationship and handling, care, and compliance.

Chapter 6: Factors Affecting Comfort and Vision 
Scleral lenses are life-changing because of their unique binomial between the higher comfort and the superior lens optics. This chapter has the purpose of illustrating the factors that may affect comfort and visual acuity and quality, allowing to identify the etiology starting from these two most prominent symptoms.

Chapter 7: Front Surface Optics 
Despite the benefit of the post fluid layer correcting corneal regular and irregular astigmatism, residual astigmatism and aberrations may remain, resulting in not optimal visual performance. 

Also, patients wearing scleral lenses may be presbyopes, needing correction for near vision, or present binocularity anomalies. This chapter discusses all the options that may be added to the anterior surface of a scleral lens to optimize visual quality and quality and restore problems with binocular vision.

Chapter 8: 
Scleral lens hygiene and care protocols are more intricate than other lens modalities. The correct use of solutions and planned replacement of the lenses, solutions, case and plungers are important in order to decrease the risk of complication associated with scleral lens wear. Handling, care, replacement schedules, and cleaning, disinfection, storing, and rinsing solutions are discussed in this chapter.

Quick-Find Index 
This quick find index is to summarize all the issues and complications, their symptoms, clinical signs, etiology, management, and observation. Three tables have been made: the first one is to expose the clinical signs and issues observed with the scleral lens applied on the eye, the second one is to illustrate the clinical signs and issues observed after scleral lens removal, and the third one is to represent the complications related to the scleral lens wear.

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