Scleral Lenses for Keratoconus
Understanding Scleral Lenses and How They Help Keratoconus
Scleral lenses are large, rigid contact lenses made from oxygen-permeable material. Unlike soft lenses that sit directly on your cornea, scleral lenses vault over the entire cornea and rest on the conjunctiva overlying the sclera. This unique design allows the lens to form a smooth optical surface without touching the irregular cone.
Because they are larger than traditional hard lenses, scleral lenses create a fluid-filled space between the lens and your cornea. This liquid reservoir not only helps correct vision but also provides moisture and protection during wear.
Keratoconus causes your cornea to bulge into an irregular cone shape, scattering light and creating distortion. Scleral lenses work by replacing the uneven corneal surface with a smoother, more regular optical surface. The saline layer fills in the gaps and creates a new refractive interface.
Light entering your eye passes through this smooth lens surface instead of the irregular cornea, allowing it to focus properly on your retina. Many patients experience significant improvement in clarity and reduction in glare or halos after a successful fitting. Results vary based on scarring, tear film, and fit.
Soft contact lenses drape over your cornea, so they take on the same irregular shape as the cone. This means they cannot mask the distortion caused by keratoconus. Regular rigid gas permeable lenses can provide clearer vision, but they rest on the cone itself and may feel uncomfortable or move around excessively.
- Soft lenses conform to the irregular cornea and fail to correct distortion
- Standard rigid lenses press on the cone and may cause discomfort or rub against sensitive tissue
- Smaller hard lenses can shift or pop out more easily, especially with advanced keratoconus
- Neither option provides the protective fluid reservoir that scleral lenses offer
We may recommend scleral lenses if you have moderate to advanced keratoconus that no longer responds well to glasses or standard contact lenses. They work especially well if you have an irregular cornea that makes other lenses uncomfortable or unstable. Patients with severe dry eye or corneal scarring from keratoconus also tend to do very well with sclerals.
You should be willing to learn proper insertion and removal techniques and commit to daily cleaning routines. Most people of any age can wear scleral lenses as long as they can handle the lenses safely and follow our care instructions.
Benefits of Scleral Lenses for Keratoconus
One of the biggest advantages of scleral lenses is the quality of vision they provide. Because the lens vaults over the entire irregular cornea and stays centered, you get consistently sharp sight that does not fluctuate with blinking. Many patients report seeing better than they have in years, with less ghosting, halos, and blur.
The large diameter and stable fit mean the lens typically stays well centered on your eye, so your vision remains clear even during physical activity or when you look in different directions.
Traditional rigid gas permeable lenses rest directly on the cornea, which can feel like a pebble on the sensitive cone. Scleral lenses vault completely over the cornea and land gently on the less sensitive conjunctiva. Most patients find this design much more comfortable, especially after the initial adjustment period.
- No contact with the fragile corneal cone reduces irritation and foreign body sensation
- The fluid cushion soothes the eye and protects it from wind and dust
- Less awareness of the lens once it is inserted and settled
- Many wearers can comfortably use their lenses for twelve to sixteen hours a day
Because scleral lenses are large and rest on a stable area of the eye, they stay in place remarkably well. You can exercise, play sports, or go about your daily activities with a lower risk of dislodging than smaller GP lenses, though dislodgement can still occur. This stability is especially important for people with advanced keratoconus, where smaller lenses tend to shift or fall out frequently.
The secure fit also means fewer interruptions to reposition or reinsert your lens during the day, giving you greater confidence and freedom.
The liquid reservoir between the lens and your cornea helps keep your eye surface moist during wear. This built-in hydration can be a game changer if you have dry eyes along with keratoconus. The lens also acts as a protective shield, blocking wind, dust, pollen, and other irritants that can make eyes feel gritty or uncomfortable.
We often see patients with both keratoconus and chronic dry eye experience relief from burning and grittiness once they switch to scleral lenses.
Drawbacks and Challenges of Scleral Lenses
Scleral lenses are custom-made devices that require advanced fitting technology and expertise. The initial cost typically includes the eye exam, corneal mapping, trial lenses, and the final custom pair. This total can be several times higher than standard contact lenses. Some vision insurance plans offer partial coverage, but many still leave a significant out-of-pocket expense.
It is important to ask our office about pricing and insurance benefits before you begin the fitting process so you can plan accordingly.
Getting the perfect fit for scleral lenses usually takes multiple appointments. We need to map your cornea precisely, try different lens designs, and make adjustments to ensure comfort and optimal vision. This process can take several weeks or even a few months, especially if your keratoconus is advanced or asymmetric.
- Initial exams and corneal topography to measure the shape of your eye
- Multiple trial fittings to test different lens sizes and curves
- Training sessions to teach you insertion, removal, and care techniques
- Follow-up visits to fine-tune the fit and check eye health
Scleral lenses must be cleaned and disinfected every day to prevent infections and keep them clear. You will need to use specific solutions and follow a careful routine each morning and evening. The lenses are durable but can be damaged if dropped or handled roughly, so you must be gentle and attentive.
Some patients find the daily care routine time-consuming at first, but most adapt quickly and build it into their normal schedule within a few weeks.
- Do not use tap water, bottled water, or homemade saline on lenses or accessories
- Do not swim, shower, or use hot tubs while wearing lenses
- Do not top off or reuse solution in your lens case
- Do not sleep in your lenses
- Do not share lenses or handling tools with anyone
Although scleral lenses are very safe when used correctly, problems can occur. We will teach you warning signs to watch for and schedule regular checkups to monitor your eye health and catch any problems early.
- Midday fogging and debris accumulation under the lens
- Conjunctival blanching, impingement, or discomfort from landing zone pressure
- Excessive suction, adhesion, or difficulty removing the lens
- Corneal staining, limbal irritation, or compression
- Corneal edema or reduced oxygen supply with excessive clearance or prolonged wear
- Inflammatory or allergic reactions to solutions or protein deposits
Improper fit or poor hygiene can lead to redness, irritation, or infection. These issues are often fixable with fit adjustments, hygiene changes, treatment of eyelid disease, or solution changes, but require evaluation.
The Scleral Lens Fitting Process and What to Expect
Your fitting journey begins with a comprehensive eye examination. We will check your vision, eye health, and the severity of your keratoconus. Corneal topography creates a detailed map of your cornea, showing the exact shape and steepness of the cone. This data guides us in selecting the best starting lens design for your eyes.
We may also take measurements of your sclera and eye surface to choose the right lens diameter and landing zone. These advanced imaging tools help us customize the lens to your unique anatomy.
Next, we place diagnostic trial lenses on your eyes to assess the fit. We look at how the lens vaults over the cornea, where it lands on the conjunctiva, and how well it centers and moves. We aim for appropriate clearance and support while avoiding excessive suction or compression. You will wear the trial lens for a short period so we can evaluate comfort and vision. Based on what we observe, we may try different sizes or curves during the same visit or at follow-up appointments.
- We check the clearance over the cornea to ensure no touch points
- We assess the alignment on the conjunctiva for even, stable support
- We measure your vision with the trial lens to confirm improvement
- We adjust lens parameters and order your custom pair once the fit is ideal
Once your custom lenses arrive, we will schedule a training session to teach you insertion and removal. Scleral lenses are larger than other contacts, so the technique is different. You will use a small plunger or your fingertips to apply the lens after filling it with sterile saline. Removing the lens also requires a gentle suction tool or a specific finger method.
We will guide you step by step and give you plenty of time to practice under our supervision. Most patients master the skills within one or two sessions, though some need a bit more practice at home before they feel fully confident.
After you start wearing your scleral lenses full time, we will see you for follow-up appointments. These visits let us examine how the lenses sit on your eyes after hours of wear and make sure your corneas remain healthy. If you experience discomfort, vision changes, or lens fogging, we may modify the lens design or adjust your care routine.
Regular checkups are essential to ensure long-term success and to update your prescription or lens parameters if your keratoconus progresses.
Living with Scleral Lenses: Daily Care and Maintenance
Every morning, you will clean your lens and then fill the bowl with sterile preservative-free saline before putting it on your eye. Hold the lens steady using a plunger or between your fingers, look down, and gently place it on the conjunctiva. The saline should stay in the bowl without spilling, creating the fluid reservoir that vaults over your cornea.
- Wash your hands thoroughly and dry them with a lint-free towel
- Rinse the lens with sterile preservative-free saline as directed
- Fill the lens bowl completely with sterile preservative-free saline
- Position the lens on your eye and release it slowly to avoid trapping air bubbles
- Blink gently to help the lens settle into place
Use only the sterile single-use preservative-free saline we prescribe for filling the lens bowl. Do not fill with multipurpose disinfecting solution or other products.
At the end of the day, remove your lens using a small suction tool designed for scleral lenses or by using your fingers to break the seal carefully. Once out, clean the lens according to the specific product instructions we prescribe. Rinse thoroughly and store the lens in fresh disinfecting solution overnight.
Never reuse old solution or rinse your lens with tap water, as this can introduce harmful bacteria or parasites that cause serious eye infections. Do not swim, use hot tubs, or shower while wearing scleral lenses. Avoid any water contact with lenses, lens cases, plungers, or filling solution. If lenses are exposed to water, remove them, disinfect thoroughly, and contact us if any irritation, redness, or blurred vision develops.
Clean your insertion and removal tools after each use and replace them periodically. Never rinse plungers or other accessories with tap water.
Store your lenses in a clean case filled with the solution we recommend. Replace your lens case every one to three months to prevent contamination. Scleral lenses themselves typically last one to three years, depending on how well you care for them and whether your prescription changes. You will need to budget for replacement lenses, solutions, and supplies as part of your ongoing costs.
Mark your calendar for annual or semi-annual eye exams so we can monitor your lenses and eye health and order new lenses when needed.
Occasionally, you may notice clouding or fogging under the lens, often caused by debris, mucus, or protein buildup in the fluid reservoir. If this happens, you may need to remove the lens, rinse it, refill with fresh saline, and reinsert. Some patients experience mild discomfort or awareness of the lens after many hours of wear, which usually improves with a short break or lens adjustment.
If fogging or discomfort happens frequently, let us know so we can check the fit and rule out other causes like incomplete lens clearance or solution sensitivities.
Remove the lens immediately and do not reinsert it until you are evaluated. Contact our office right away if you develop sudden pain, redness, light sensitivity, discharge, or vision loss. If you cannot reach our office promptly, seek same-day urgent eye care or emergency evaluation. Do not ignore persistent discomfort or any sign that something is wrong, as early treatment can prevent serious complications.
- Painful red eye with light sensitivity, especially if not improving after lens removal
- Reduced vision that persists after removing the lens
- Severe or worsening eye pain that does not go away after lens removal
- A new white spot on the cornea or increasing haze
- Thick discharge or crusting on the eyelids
- New flashes, floaters, or a curtain or shadow over your vision (retinal emergency)
Comparing Scleral Lenses to Other Keratoconus Treatment Options
Rigid gas permeable lenses are smaller hard lenses that rest on the cornea. They can provide excellent vision for mild to moderate keratoconus, but many patients find them less comfortable because they sit directly on the cone. RGP lenses may also move more and dislodge easily compared to the stable fit of sclerals.
Scleral lenses offer better comfort, more stable vision, and built-in moisture for most people with keratoconus. However, RGP lenses cost less and have a simpler fitting process, so we may try them first for patients with milder disease.
Hybrid lenses combine a rigid center for clear vision with a soft outer skirt for comfort. They can work well for some keratoconus patients who want better comfort than RGP lenses but do not need the extreme vaulting of sclerals. However, hybrid lenses are more fragile, require careful handling, and may not provide enough clearance for advanced cones.
We may consider hybrid lenses for patients with early keratoconus, but scleral lenses remain the preferred choice for moderate to severe cases or when corneal irregularity is pronounced.
In addition to standard scleral lenses, several other specialty contact lens designs may be considered depending on your specific needs and the severity of your keratoconus. Custom soft lenses designed for keratoconus can work for some patients with very mild irregular astigmatism. Piggyback systems, where a soft lens is worn under a rigid lens, may improve comfort for patients who cannot tolerate GP lenses alone but do not need full scleral vaulting.
We will evaluate your corneal shape, comfort needs, and visual goals to determine which lens type offers the best combination of clarity, stability, and wearability.
Corneal cross-linking is a procedure that strengthens the cornea and can slow or stop keratoconus progression. As of 2025, it is a well-established treatment for patients with documented worsening of their cone shape. Cross-linking is not primarily a vision-correction procedure. Some patients notice modest visual or topographic improvement, but many still need specialty lenses for optimal sight.
Timing matters when combining treatments. Lens prescriptions may change after cross-linking as the cornea stabilizes and reshapes.
In advanced cases where the cornea is too scarred or thin, we may discuss options such as intracorneal ring segments or corneal transplant surgery. Transplant type varies, and many patients still need specialty lenses afterward. If keratoconus is stable and vision can be corrected with scleral lenses, surgery is usually not necessary. We will evaluate your specific situation and discuss all options with you.
It is common to use scleral lenses along with other therapies. For example, you might undergo corneal cross-linking to halt progression and then wear scleral lenses for daily vision correction. Some patients also use medicated eye drops for dry eye or allergies while wearing their lenses. We will coordinate all aspects of your care to ensure treatments work together safely.
Always tell us about any eye drops, medications, or procedures you are using so we can adjust your lens care routine if needed.
Frequently Asked Questions
Most scleral lenses last between one and three years with proper care and cleaning. Over time, deposits can build up on the lens surface, the lens may develop scratches or surface changes affecting clarity and comfort, so we will monitor the condition of your lenses at regular visits. If your keratoconus changes or your prescription shifts, you may need new lenses sooner to maintain the best vision and fit.
We do not recommend sleeping in scleral lenses. Your cornea needs regular oxygen exposure overnight to stay healthy, and wearing lenses while you sleep can reduce oxygen flow and increase the risk of infection or corneal swelling. Always remove your lenses before bed and give your eyes a break during sleep.
Scleral lenses correct your vision but do not treat the underlying disease or prevent keratoconus from progressing. If your cornea continues to change shape, we may need to adjust or replace your lenses over time. For patients with active progression, corneal cross-linking is the treatment designed to strengthen the cornea and halt further bulging.
Contact our office as soon as possible to order a replacement lens. We keep your lens specifications on file, so we can reorder the same design without starting the fitting process over. It is a good idea to have a backup pair on hand, especially if you rely on your scleral lenses every day and cannot function well without them.
Yes, scleral lenses are often an excellent choice for people with dry or sensitive eyes. The fluid reservoir keeps your cornea bathed in moisture throughout the day, which can relieve dryness symptoms. The lens also shields your eye from air, wind, and allergens that might irritate sensitive eyes. Many patients find their eyes feel more comfortable in scleral lenses than in any other type of contact lens.
Getting Help for Scleral Lenses for Keratoconus
If you think scleral lenses might be right for your keratoconus, schedule a consultation with our eye doctor. We will evaluate your eyes, discuss your vision goals, and explain the fitting process in detail. With the right lenses and proper care, you can enjoy clear, comfortable vision and get back to the activities you love.