New Scleral Lens Advancement
Understanding Scleral Lenses and What's New
Regular contact lenses sit directly on your cornea, the clear front surface of your eye. Scleral lenses are larger and arch over the cornea without touching it, landing instead on the conjunctiva that covers the sclera, or white part of your eye. This unique design creates a protective cushion of fluid between the lens and your cornea.
Because they do not rest on the sensitive cornea, scleral lenses tend to be more comfortable for people who struggle with conventional contacts. They also stay in place better during activities and may resist drying better than smaller lenses, though some patients still experience dryness symptoms.
The space between the back of a scleral lens and the front of your cornea is called the vault. This vault is filled with sterile saline solution when you insert the lens, forming a liquid reservoir. The fluid layer bathes your cornea continuously, keeping it moist and comfortable throughout the day.
- The vault height is customized to your eye shape and condition
- Fluid stays locked in place during normal blinking and movement
- The reservoir helps smooth out corneal irregularities for clearer vision
- Lenses can settle over hours of wear, so follow-up visits ensure adequate clearance is maintained
Modern scleral lenses are made from highly breathable materials that allow oxygen to reach your cornea even through the fluid reservoir. We fit patients with lenses constructed from advanced polymers that offer improved oxygen permeability compared to older scleral lens materials.
Higher-Dk materials can improve oxygen transmission, but overall oxygen delivery also depends on lens thickness and the fluid reservoir. These new materials also resist deposit buildup and maintain their shape and clarity over many months of daily use, supporting corneal health and comfortable wearing times for most wearers.
We use sophisticated corneal topography and imaging systems to create a detailed three-dimensional map of your cornea and the front portion of your eye surface. This data guides the design of lenses that match the unique contours of your cornea and sclera with remarkable precision.
Advanced mapping technology has transformed scleral lens fitting from a trial-and-error process into a science. The result is a lens that fits your eye like a custom-tailored garment, often with fewer trial lenses and maximizing both comfort and visual performance.
Recent innovations in lens edge design and surface treatments make today's scleral lenses smoother and more comfortable to insert and remove. Many patients who were hesitant about handling large lenses find the new designs surprisingly easy to manage after just a few practice sessions.
- Rounded, polished edges reduce awareness of the lens on your eye
- Color tints and handling marks help you orient the lens correctly
- Thinner profiles may reduce overall lens weight without sacrificing durability
Conditions We Treat with Advanced Scleral Lenses
Keratoconus causes your cornea to thin and bulge into a cone shape, making it nearly impossible to achieve clear vision with glasses or regular contacts. Scleral lenses vault over the irregular surface and use the fluid reservoir to create a smooth optical interface, often restoring vision to excellent levels.
Scleral lenses are a leading option for vision correction and comfort in keratoconus. If keratoconus is progressing, your doctor may also discuss treatments intended to slow progression, such as corneal cross-linking. Other vision correction options your doctor may consider include custom soft lenses, corneal rigid gas-permeable lenses, hybrid lenses, or in selected cases surgical interventions such as intracorneal ring segments or corneal transplant.
For patients with chronic dry eye or ocular surface disorders, the constant bathing of the cornea in preservative-free saline can provide dramatic relief. The lens acts as a protective shield, preventing evaporation and exposure while delivering continuous moisture.
- Severe aqueous-deficient dry eye that does not respond to drops or other medical therapy
- Graft-versus-host disease affecting the ocular surface
- Stevens-Johnson syndrome or other scarring conditions
- Exposure keratopathy from incomplete eyelid closure
After corneal transplant surgery or procedures like radial keratotomy or LASIK, some patients develop irregular astigmatism that glasses cannot correct. Scleral lenses can restore functional vision by masking these irregularities with the fluid layer.
We work closely with corneal surgeons to fit scleral lenses once your eye has healed sufficiently. Timing depends on healing, sutures, and stability of the cornea and prescription. Some patients can be fit within months, while others need longer. For transplant eyes, we monitor closely for signs of corneal swelling or changes in the health of the transplanted tissue.
If you have severe astigmatism or a complex prescription that includes high degrees of nearsightedness or farsightedness, scleral lenses can provide sharper vision than conventional options. The rigid material and custom design correct even challenging refractive errors with precision.
Advanced manufacturing allows us to incorporate toric back surfaces for astigmatism correction, front surface corrections, and even multifocal zones for near and distance vision into scleral lenses, addressing your unique visual needs at all distances.
Scars from infections, injuries, or chemical burns can distort your cornea and permanently reduce vision quality. Scleral lenses sit over the scarred areas without touching them, using the tear reservoir to neutralize optical distortions and protect the damaged tissue from further irritation.
- Scars from herpes simplex or bacterial keratitis
- Corneal abrasions or lacerations that healed with irregularities
- Chemical or thermal burns affecting the front of the eye
The Fitting and Customization Process
Your fitting journey begins with comprehensive imaging. We capture detailed topography maps that measure the curvature of your cornea at thousands of points, as well as scans that assess the shape of your sclera. These measurements form the blueprint for your custom lenses.
The imaging process is quick, comfortable, and completely non-invasive. You simply rest your chin on a support while the instrument captures the data in seconds.
After reviewing your scans, we select diagnostic trial lenses that closely match your eye shape and prescription. You will try these lenses in our office so we can evaluate the fit, vault clearance, and edge alignment under magnification.
- We check how the lens centers and moves with blinking
- We assess the fluid reservoir depth over your cornea
- We observe the landing zone, where the lens rests on your eye, for even contact
- You provide feedback on comfort and initial vision clarity
Plan to spend about one to two hours at your initial fitting visit. Our team will teach you how to insert and remove the lenses using a small plunger tool and a mirror. We will walk you through each step until you feel confident performing the process yourself.
Many patients master insertion and removal during the first appointment, though some prefer to return for additional coaching. We also review the cleaning and filling routine so you are fully prepared to care for your new lenses at home.
Even with advanced imaging, achieving the perfect fit often requires adjustments. After wearing your first pair for a week or two, we examine your eyes carefully to check for any areas of excessive pressure or inadequate clearance. We may modify the lens parameters and order a refined version.
This iterative process ensures that your final lenses provide optimal comfort, vision, and corneal health. Each refinement brings you closer to the ideal fit tailored specifically for your eyes.
From your first appointment to receiving your final custom lenses, the process typically takes four to eight weeks. Complex cases or those requiring multiple adjustments may extend a bit longer, while straightforward fits can sometimes be completed more quickly.
- Initial imaging and diagnostic fitting: one visit
- First custom lens delivery and training: one to two weeks later
- Follow-up evaluations and any needed refinements: two to four weeks
Wearing and Adapting to Your Scleral Lenses
When you first begin wearing scleral lenses, your eyes need time to adjust to the sensation of a larger lens. You may notice mild awareness of the lens edge or slight fogging of vision as your tear film stabilizes. These sensations usually fade within hours to a few days.
We recommend starting with just a few hours of wear on day one and gradually building up your tolerance. If you experience persistent discomfort or redness, contact our office before continuing.
Most patients add one to two hours of wearing time each day during the first week. By the end of week one, many people comfortably wear their lenses for six to eight hours. By week two, full-day wear is often achievable.
- Day one: two to four hours
- Day two or three: four to six hours
- Days four to seven: six to eight hours
- Week two and beyond: eight to twelve hours or more
Once you complete the adaptation period, scleral lenses typically provide stable, crisp vision from morning until evening. Some patients experience fogging or debris accumulation in the reservoir during the day and may need to remove, rinse, and reinsert the lens for continued clarity and comfort.
Many patients report that scleral lenses feel more comfortable after several hours of wear than traditional soft lenses, especially if they have dry eyes or sensitive corneas. Recent advancements in lens geometry and materials have reduced common issues like midday fogging, lens settling, and edge awareness.
While scleral lenses are very safe when worn and cared for properly, they carry risks and are not suitable for everyone. Understanding these factors helps you make informed decisions and recognize when to seek care.
- Microbial keratitis or corneal ulcer from contamination or overwear
- Corneal swelling or hypoxia if oxygen delivery is inadequate
- Corneal staining or epithelial defects from poor fit or solution reactions
- Allergic reactions, giant papillary conjunctivitis, or inflammation
- Conjunctival redness, hemorrhage, or prolapse from suction or tight lens fit
- Fogging requiring midday lens removal and refill
- Not recommended for patients with active eye infection, severe untreated blepharitis, glaucoma filtering blebs or drainage tubes in some cases, or those unable to handle lenses hygienically
- Special caution needed for eyes with low corneal endothelial cell counts, reduced corneal sensation, or large pinguecula or pterygium
While scleral lenses are very safe when worn and cared for properly, certain symptoms require immediate attention. These symptoms can represent a corneal infection or ulcer and require same-day evaluation. If you cannot reach our office promptly, go to an urgent care or emergency department.
Remove your lenses right away and contact our office if you notice any of the following. Bring your lenses, case, and solutions to your evaluation so we can check for contamination or toxicity.
- Sudden sharp pain or significant discomfort
- Rapid onset of redness or bloodshot appearance
- New light sensitivity with tearing
- Blurry vision that does not clear after blinking or removing the lens, or worsening vision loss
- Discharge, crusting, or signs of infection
- A white spot on the cornea or severe pain that persists after lens removal
Caring for Your Scleral Lenses Daily
Every time you remove your lenses, clean them thoroughly to remove debris and protein buildup. Use an RGP-approved daily cleaner and gently rub both sides of the lens with your fingertips, then rinse as directed. After cleaning, rinse the lenses with preservative-free saline and place each lens in a clean case filled with fresh multipurpose or hydrogen peroxide disinfecting solution approved for rigid gas-permeable lenses.
Hydrogen peroxide systems must fully neutralize before lenses touch your eye. Never rinse or store lenses in unneutralized peroxide, do not use peroxide to fill the lens, and follow the manufacturer's neutralization instructions carefully. Avoid using tap water, saliva, or solutions designed only for soft contact lenses, as these can damage your scleral lenses or introduce harmful microorganisms. Always follow the disinfection time recommended by the solution manufacturer, typically at least four to six hours.
Before inserting a scleral lens, you fill its bowl completely with non-preserved sterile saline. This fluid becomes the reservoir that bathes your cornea throughout the day. Using preservative-free saline is essential because preservatives can irritate your eye when trapped under the lens.
Use sterile, non-preserved saline intended for scleral lens filling. Avoid reusing opened single-use vials and avoid touching the tip to prevent contamination. Hold the lens steady in a small insertion tool or on your fingertips, fill the bowl to the brim while avoiding bubbles, and bring the filled lens carefully to your eye and apply it in one smooth motion.
Insertion requires filling the lens bowl, positioning yourself over a mirror and a clean towel, and gently placing the lens onto your eye while looking straight ahead. A small plunger tool helps you hold the lens steady and release it once it is in place.
Removal involves breaking the seal between the lens edge and your eye, either by gently pressing near the edge or using a small removal plunger. With practice, most patients insert and remove their lenses confidently within a minute or two.
Scleral lenses are designed to last one to two years with proper care, though some patients may need replacement sooner if their prescription changes or the lenses develop deposits or scratches. We will check your lenses at every follow-up visit and let you know when it is time to order a new pair.
- Replace your lens case every one to three months and allow it to air-dry between uses
- Discard saline based on the manufacturer's post-opening instructions; many are single-use or must be discarded within a defined period after opening
- Never top off old solution; always use fresh solution in your case
- Do not rinse your case with tap water
When you travel, bring extra saline, disinfecting solution, and a backup lens case. Pack these items in your carry-on luggage so you have access to them if your checked bag is delayed. It is also wise to carry a copy of your lens prescription and our office contact information.
Consider packing a spare pair of lenses if you have them, along with your glasses, so you have a backup option in case a lens is lost or damaged while you are away from home.
Frequently Asked Questions
With diligent daily cleaning and proper handling, most scleral lenses remain in good condition for one to two years. The exact lifespan depends on your tear chemistry, how carefully you handle the lenses, and whether your prescription or eye shape changes over time.
Scleral lenses stay in place exceptionally well during athletic activities because they vault over the cornea and rest on the conjunctiva overlying the sclera. However, we do not recommend wearing any contact lenses while swimming or in hot tubs, as water can introduce bacteria and significantly increase your risk of serious eye infection.
Coverage varies widely depending on your plan and the medical reason for the lenses. Many insurance carriers cover scleral lenses as medically necessary treatment for conditions like keratoconus, corneal transplant, or severe dry eye, but routine vision plans may not. Our staff can help you verify your benefits and submit claims on your behalf.
Scleral lenses offer excellent vision correction without the risks or recovery time of surgery. They are fully reversible, meaning you can stop wearing them at any time, and they can be updated as your eyes change. In many cases, scleral lenses can provide outstanding vision, and they are reversible. In other cases, surgery or combined approaches may be recommended depending on corneal health and your goals.
Overnight wear of scleral lenses is not routinely recommended. Wearing lenses while you sleep reduces oxygen delivery to your cornea and increases the risk of complications. Always remove your lenses before napping or going to bed unless our eye doctor has specifically approved overnight wear for your unique situation as part of a supervised therapeutic protocol.
If you suspect an infection, stop wearing your lenses immediately and call our office. Signs include redness, pain, discharge, or sudden vision changes. Prompt treatment is essential to prevent serious damage, and we will examine you urgently to determine the cause and prescribe appropriate therapy.
Schedule a Consultation for Advanced Scleral Lenses
If you are struggling with vision problems that glasses or regular contacts cannot solve, or if you have a corneal condition affecting your comfort and sight, we encourage you to schedule a consultation. Our team will evaluate your eyes, discuss whether advanced scleral lenses are right for you, and guide you through every step of the fitting and adaptation process.