Who is a Good Candidate for Scleral Lenses?
Understanding Scleral Lenses
Scleral lenses are advanced medical devices that work differently than standard soft or hard contacts. Their unique design provides a protective liquid cushion over your cornea that can improve both vision and all-day comfort.
These specialized lenses create a perfectly smooth optical surface over an irregular or damaged cornea by holding a thin layer of preservative-free saline. This fluid-filled space masks surface irregularities, corrects vision distortions, and provides constant hydration to shield the eye from friction and air exposure.
Unlike soft lenses that drape over the cornea or smaller rigid gas permeable (RGP) lenses that rest directly on it, scleral lenses vault completely over the cornea without touching it. This design is ideal for sensitive or irregularly shaped corneas, providing superior stability and comfort since the sclera has fewer nerve endings.
Each scleral lens is custom-made based on detailed 3D maps of your eye's unique shape. The fitting process involves a comprehensive eye exam and trial lenses to ensure a precise fit that maximizes vision and comfort while maintaining long-term eye health. This requires multiple visits to fine-tune the lens for your specific needs.
Common Eye Conditions That Benefit
Many eye conditions make wearing regular contact lenses difficult or impossible. Scleral lenses are often a life-changing solution for people with various corneal and ocular surface diseases.
In keratoconus, the cornea thins and bulges into a cone shape, causing blurred and distorted vision. Scleral lenses vault over this irregular surface, creating a smooth optical interface that provides much clearer and more stable vision than glasses or other contacts can achieve.
For patients with severe dry eye from conditions like Sjogren's Syndrome or graft-versus-host disease, the fluid reservoir under a scleral lens acts like a constant liquid bandage. It provides continuous moisture and protection, significantly reducing symptoms like burning, grittiness, and light sensitivity.
Patients who have had corneal transplants (keratoplasty), complications from refractive surgery like LASIK, or eye injuries may be left with an uneven corneal surface. Scleral lenses bypass these irregularities, often restoring functional vision when other options have failed.
Inherited conditions like Fuchs' Dystrophy or Pellucid Marginal Degeneration can affect the cornea's clarity and shape. Scleral lenses can manage symptoms by creating a smooth refractive surface, improving vision quality and potentially delaying the need for surgical intervention.
This condition occurs when corneal nerves are damaged, reducing sensation and impairing the eye's ability to heal. The protective fluid layer under a scleral lens shields the vulnerable cornea, promoting healing and preventing further damage from exposure.
Autoimmune conditions like Stevens-Johnson Syndrome or Ocular Cicatricial Pemphigoid can cause severe scarring of the eye surface. Scleral lenses act as a prosthetic shield, improving comfort and vision while protecting the remaining healthy tissue from damage caused by blinking.
Qualities of an Ideal Candidate
While scleral lenses can help many people, a successful experience depends on a patient's personal circumstances, motivation, and commitment to proper care.
Scleral lenses require more steps to insert, remove, and care for than regular contacts. Ideal candidates are motivated to learn the proper techniques and are patient during the initial adjustment period, which is key to long-term success.
Proper hygiene is crucial to prevent serious eye infections. Good candidates understand the importance of following all cleaning and disinfection instructions exactly and are willing to invest the time in daily lens maintenance.
While scleral lenses often provide dramatic vision improvement, they may not restore perfect 20/20 vision in every case, especially with advanced corneal disease. Successful candidates understand their likely outcomes and are satisfied with significant functional improvement.
Because these lenses are larger, handling them requires steady hands. Ideal candidates are comfortable touching the area around their eyes and can manage the insertion and removal process, though tools are available to help.
Scleral lens fitting is a process, not a single appointment. Successful wearers must commit to attending all scheduled follow-up visits to ensure the lens fit remains safe and the eye stays healthy over the long term.
Benefits and Considerations
Scleral lenses offer unique advantages, but they also come with important responsibilities that patients should understand before starting treatment.
The fluid-filled space neutralizes corneal irregularities more effectively than any other non-surgical option. Many patients experience their best-ever vision, with improved sharpness, reduced glare, and better stability throughout the day.
The constant hydration soothes dry, irritated, or damaged corneas. Most patients can wear their lenses comfortably all day, a significant improvement over other lens types that may have been intolerable.
The lens shields the cornea from environmental irritants like wind, dust, and dry air. For patients with surface disease or injury, this protection can promote healing while maintaining functional vision.
Scleral lenses are custom medical devices and require a higher initial investment for fitting fees and materials. Ongoing costs include special cleaning solutions and periodic lens replacement, typically every one to two years.
Successful scleral lens wear depends heavily on the skill of the eye doctor. It is critical to work with a practitioner who has advanced training and experience in fitting these specialized lenses to manage the process and any potential complications.
Frequently Asked Questions
Here are answers to common questions patients ask about scleral lenses, who can benefit from wearing them, and what to expect from the process.
Children with conditions like keratoconus or severe dry eye may benefit from scleral lenses, especially if other options fail. Success depends on the child's maturity, ability to handle the lenses, and strong parental involvement for cleaning and care.
Most patients notice immediate vision improvement, but full comfort adjustment can take anywhere from a few days to a couple of weeks. Initial awareness of the lens is normal and typically fades with consistent wear as you get used to the sensation.
Scleral lenses are exceptionally good at correcting irregular astigmatism from the cornea. They can also be made to correct regular astigmatism from the cornea or the lens inside the eye, providing comprehensive vision correction.
Lenses must be cleaned daily after removal. This involves rinsing with preservative-free saline, cleaning with an approved solution, and storing them overnight in a fresh disinfecting solution, often a hydrogen peroxide-based system. Never use tap water.
If you experience significant pain, redness, or a sudden change in vision, remove the lenses immediately. Inspect the lens for debris or damage. If the problem persists after rinsing and reinserting, contact your eye doctor right away.
No, scleral lenses are designed for daily wear only and must be removed before sleeping. Wearing them overnight significantly increases the risk of serious eye infections and other complications due to reduced oxygen to the cornea.
You should avoid swimming, showering, or using hot tubs while wearing scleral lenses. Water can introduce harmful microorganisms that may get trapped behind the lens and cause severe infections.
With proper care, most scleral lenses last for one to two years. They may need to be replaced sooner if they become scratched, warped, or develop protein deposits that cannot be removed, or if your prescription changes.
Yes, many patients find their light sensitivity (photophobia) improves. By creating a perfectly smooth surface, the lenses reduce the light scattering caused by an irregular cornea. Lenses can also be made with a custom tint for added comfort.
Yes, but you should always insert your lenses before applying makeup and remove your lenses before washing it off. Use oil-free, hypoallergenic products and avoid applying eyeliner to the inner eyelid margin to prevent irritation.
Most patients with controlled glaucoma can safely wear scleral lenses. It is essential to inform your specialty lens fitter about your condition and all medications so they can monitor your eye pressure and ensure the fit is safe.
Because of their large size, some patients may be slightly aware of the lens edge in their far peripheral vision initially. However, this sensation usually fades with adaptation and does not functionally restrict the visual field.
Coverage varies widely. Many medical insurance plans will cover scleral lenses when they are deemed 'medically necessary' for conditions like keratoconus or severe dry eye. Our office staff can help you verify your benefits and submit for prior authorization.
Scleral lenses are very stable on the eye and are an excellent option for most sports and physical activities. Their secure fit makes them much less likely to become dislodged compared to smaller RGP lenses.
Contact our office immediately. Because the lenses are custom-made, a replacement can take time to fabricate. It is highly recommended to have a spare pair of lenses and an up-to-date pair of backup glasses.
Yes, scleral lenses are often an excellent way to improve vision after a corneal transplant. They vault over the graft-host junction and can correct significant astigmatism or surface irregularity that may remain after surgery.
The most common side effect is temporary discomfort or foggy vision during the adaptation period. With improper care, there is a risk of infection or corneal swelling. Following all hygiene guidelines and attending follow-up appointments minimizes these risks.
Next Steps
If you are struggling with vision or discomfort from a complex eye condition and think scleral lenses might be right for you, schedule a consultation. Our specialty lens team will perform a comprehensive evaluation to determine if you are a candidate and guide you through the custom fitting process.