Scleral Contact Lenses
What Are Scleral Contact Lenses?
Scleral lenses are a special type of rigid gas-permeable lens larger than regular contacts that vault over the cornea. Their customization and advanced materials make them effective for complex eye conditions by creating a protective, fluid-filled layer between the lens and the eye.
Scleral lenses are made of gas-permeable materials that allow oxygen to pass through to the eye. They usually measure between 14.5 mm and 24 mm in diameter, which is much larger than standard soft contact lenses. The edge of the lens rests on the sclera (the white part of the eye), not the cornea, which helps keep the lens stable and comfortable throughout the day.
Modern scleral lenses use advanced materials such as fluorosilicone acrylates and silicone hydrogels that combine excellent oxygen permeability with superior surface wettability. These materials help maintain corneal health during extended wear while resisting protein deposits.
When placed on the eye, scleral lenses vault over the cornea and rest on the sclera. Before insertion, the lens is filled completely with a sterile saline solution. This creates a smooth, tear-filled cushion over the cornea that helps correct irregular vision and protects the cornea's surface.
The vault typically measures between 300 and 500 microns immediately after insertion. Over the course of eight hours, the lens settles by approximately 100 to 200 microns, maintaining a safe clearance that protects the corneal surface.
The space between the lens and the cornea holds tears and saline solution. This extra fluid cushions the cornea and keeps it moist all day long. Patients with dry eye often find scleral lenses more comfortable because of this tear reservoir, and it also helps heal minor corneal scratches by protecting the eye from irritation.
Modern scleral lenses use highly oxygen-permeable materials that allow sufficient oxygen to reach the cornea despite their larger size. Maintaining corneal oxygenation is crucial for eye health and preventing complications. Your eye care provider will select lenses with appropriate oxygen permeability based on your eye's needs.
Scleral lenses can be precisely customized for size, shape, and curvature to match the unique contours of each patient's eye. Advanced fitting technologies including three-dimensional corneal and scleral modeling and computer-aided lens design allow for better comfort, stability, and vision correction compared to standard lenses. Some patients may benefit from toric haptic zones that account for asymmetry in the scleral surface.
Who Can Benefit from Scleral Lenses?
Scleral lenses are designed to help many people who cannot wear regular contact lenses or who have special eye needs. Because of their unique design, they are well suited to improve both vision and comfort for a variety of complex and challenging cases.
Keratoconus is a condition where the cornea thins and bulges into a cone shape. Regular lenses may not fit well or provide clear vision for this condition. Scleral lenses vault over the irregular cornea, creating a smooth optical surface that greatly improves vision for keratoconus patients.
Patients throughout the Manchester and Greater Hartford area with corneal irregularities experience sharper, more stable vision with these specialized lenses.
People with severe dry eye may find soft contact lenses uncomfortable or intolerable. The tear reservoir under a scleral lens keeps the eye surface moist and protected. This reduces irritation, redness, and dryness, allowing for better comfort and longer wear times.
After corneal surgeries such as corneal transplants, LASIK, or other refractive surgeries, the shape of the cornea can change or become irregular. Scleral lenses protect the healing cornea and correct vision by filling in surface irregularities, allowing patients to see clearly while the eye recovers.
Some people cannot tolerate soft or standard rigid lenses because of discomfort or poor fit. Because scleral lenses rest on the sclera, which has fewer nerve endings, many patients find them much more comfortable. Scleral lenses are often a good option for those with contact lens intolerance.
Scleral lenses can benefit patients with other conditions, including corneal dystrophies and degenerations, severe astigmatism not well corrected with glasses or standard lenses, and ocular surface diseases like Stevens-Johnson syndrome or graft-versus-host disease. Large corneal scars or irregularities impacting vision may also respond well to scleral lens therapy.
- Corneal ectasia from various causes
- Pellucid marginal degeneration
- Terrien marginal degeneration
- High refractive errors that are difficult to correct with other methods
In selected pediatric patients and those with neurological or physical disabilities, scleral lenses can offer visual rehabilitation when traditional lenses are not an option. Custom fitting and close monitoring are essential for these cases.
Fitting Scleral Contact Lenses
Getting the right fit for scleral lenses involves a careful, step-by-step process. Eye care specialists use precise tools to measure and customize the lenses for each patient's eyes to ensure maximum comfort and optimal vision correction.
Our eye doctors will capture detailed measurements of both the cornea and the sclera using devices like corneal topography or optical coherence tomography (OCT). They also assess tear film quality and overall eye health. Based on this comprehensive evaluation, a trial lens is selected to begin the fitting process safely and accurately.
The patient tries on trial lenses to check comfort and vision. The specialist evaluates the lens position, the vault over the cornea, and how the edges align on the sclera. If needed, adjustments are made to the curvature or size of the lens.
This fitting may require multiple visits to achieve the best fit. The process ensures that the lens provides adequate clearance over the cornea while resting comfortably on the sclera without causing blanching or compression.
Scleral lenses are larger and heavier than soft lenses, so using a special suction tool or plunger is often necessary for insertion and removal. The lens must be filled with preservative-free saline before placing it on the eye to create the tear reservoir. Proper training is important to avoid trapping air bubbles or damaging the cornea.
Patients learn to inspect the lens before insertion to ensure no air bubbles are present and that the cornea appears adequately vaulted. Most people master the insertion and removal technique within one to two weeks with practice.
Follow-up appointments are important to make sure the lenses remain comfortable and the eyes stay healthy. The first check-up usually occurs within a week of receiving the lenses. Subsequent visits may be scheduled every few months to evaluate the fit, vision, and eye surface condition over time.
Consideration is given to scleral shape asymmetry or elevation that varies across the eye, which can affect lens fit. Advanced imaging and custom designs help address these challenges. Additionally, tear volume and eyelid interaction are assessed to optimize lens performance and all-day comfort.
Care and Maintenance
Proper care of scleral lenses is essential for eye health, comfort, and lens longevity. Having a consistent daily cleaning routine and following provider instructions helps prevent infections and lens damage.
After removing the lenses, gently rub them with a cleaning solution recommended by your eye care provider. Rinse the lenses with fresh saline or multi-purpose solution. Clean both sides of each lens for 10 to 20 seconds to remove debris and protein deposits.
Soak your lenses overnight in fresh disinfecting solution to kill germs and bacteria. Never reuse old solution, and store lenses in a clean case. Replace the case every one to three months to reduce contamination risk.
Always ensure the storage case is thoroughly air-dried between uses to prevent bacterial growth. Keep the case away from sinks and bathroom counters where water splashes may occur.
Always wash and dry your hands before handling lenses. Avoid lotions or oils on your hands, as these can stick to the lenses. Work over a clean, lint-free towel to avoid dropping your lenses.
Inspect lenses for cracks, chips, or damage before inserting them. If you notice any defects or changes in the lens surface, contact your eye care provider before wearing them.
When traveling, bring extra cleaning solutions, saline, and storage cases. Avoid exposure of lenses to tap water or non-sterile fluids, which can cause infections. Use portable lens care kits for convenience and hygiene.
Potential Risks and Comfort Tips
Most people adapt well to scleral lenses, but some issues can occur early on. Understanding possible side effects and warnings promotes healthy lens wear and lasting success.
Initial discomfort, tearing, or redness can happen during the first week of wear. Mild protein buildup on the lenses may also affect comfort. These issues usually improve with time, proper cleaning, and a gradual increase in wear time.
If redness, pain, blurred vision, or discharge lasts more than a day, contact your eye care provider immediately. These symptoms may indicate infection or lens fit problems. Avoid home remedies and seek professional care promptly to prevent serious complications such as microbial keratitis or corneal edema.
- Sudden severe eye pain or light sensitivity
- Vision loss or sudden changes in vision quality
- Persistent midday fogging that does not resolve with lens removal and reinsertion
- Blood vessel growth toward the cornea
Use preservative-free artificial tears or rewetting drops as needed while wearing lenses. Take scheduled breaks during extended screen use. Always make sure the tear reservoir under the lens is free of air bubbles before wear.
Gradually increase daily wear time as your eyes get used to the lenses. Most practitioners recommend starting with two to four hours per day and adding one to two hours daily as comfort improves.
Call your eye care provider right away if you experience sudden eye pain, vision loss, sensitivity to light, or notice lens damage. Regular checkups help catch any problems early and keep your eyes healthy during lens wear.
With proper care and regular monitoring, long-term scleral lens wear is safe and effective. Your eye care provider will watch for any signs of corneal changes, infections, or complications over time to ensure ongoing eye health. Studies show that patients who follow care instructions and attend scheduled follow-ups experience excellent outcomes with minimal complications.
Frequently Asked Questions
Here are some common questions about scleral contact lenses to help you understand what to expect during your journey.
Most people adjust within a few days to two weeks. It is best to start by wearing the lenses for two to four hours per day and gradually increase wear time as comfort improves. Always follow your provider's instructions closely during this adjustment period.
Midday fogging can occur from debris in the tear reservoir. Remove the lens, rinse both sides with fresh saline, refill with new saline, and reinsert. If fogging persists, contact your provider, as a surface treatment or lens modification may be needed.
It is strongly recommended to remove lenses before swimming or showering. Water exposure increases the risk of serious eye infections. If you must swim with them, wear watertight swimming goggles to protect your eyes.
Scleral lenses typically cost more than regular contact lenses due to their specialized design, fitting process, and materials. Many insurance plans consider them medically necessary for certain conditions and may cover a portion of the cost. Check with ReFocus Eye Health Manchester and your insurance plan for details.
The main difference is size. Mini-scleral lenses (14.5 to 18 mm) are smaller and rest closer to the edge of the cornea, making them suitable for less severe conditions. Full scleral lenses (18 mm or larger) are larger, providing maximum vault over the cornea and are often used for more complex cases.
Scleral lenses generally last between one and two years, depending on the material and care. Regular inspection by your eye care provider helps detect early signs of wear, damage, or deposits. Replace lenses as recommended to maintain the best vision and eye safety.
Getting Help for Scleral Contact Lenses
If scleral contact lenses seem like a good option for you, discuss an evaluation with our eye doctors at ReFocus Eye Health Manchester. A thorough fitting process and follow-up care are important to achieve clear vision and lasting comfort.
Stephanie was a pleasure to interact with and a great introduction to the team. The doc I saw explained everything thoroughly and made the exam easy to bear.
TC Cupit
Dr. and staff were very friendly and courteous. Dr. Was very thorough in his questions about how I take my medication, and if I had any questions about them. All and all, it was a good visit.
Peggy Thuillard
I noticed that the office is cleaner and brighter. Dr. Cavanaugh was very professional and very personal. Tim was great as well. It was a very pleasant visit.
Janet Platt
Dr. Cavanaugh is absolutely excellent!. I was very concerned when Refocus took over the practice, but it has been excellent. The reception guy is very great too, very friendly and personable .
Bub H.
Staff is friendly and professional. The doctors are excellent and very attentive.
Royce Rabenold
Contact Us
Tuesday: 8AM-5PM
Wednesday: 8AM-5PM
Thursday: 8AM-5PM
Friday: 8AM-5PM
Saturday: Closed
Sunday: Closed