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.
The liquid reservoir typically ranges from 200 to 400 micrometers in depth and remains stable throughout the day. This creates an artificial tear layer that neutralizes even severe corneal irregularities, allowing light to focus properly on the retina and often restoring functional vision when other correction methods have failed.
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.
- Soft lenses conform to irregular corneal shapes but cannot mask optical irregularities
- Standard RGP lenses provide sharp optics but may move excessively on irregular corneas
- Scleral lenses combine the optical clarity of rigid materials with exceptional stability
- The larger diameter prevents lens displacement during blinking or physical activity
Each scleral lens is custom-made based on detailed 3D maps of your eye's unique shape using advanced corneal topography and optical coherence tomography. 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. Our eye doctors at ReFocus Eye Health Manchester evaluate factors including corneal clearance, limbal alignment, scleral landing zone position, and edge comfort to achieve optimal results for each patient.
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, representing approximately 36 percent of specialty lens fittings for keratoconus alone.
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.
Similar benefits extend to other ectatic conditions including pellucid marginal degeneration and post-LASIK ectasia. The lenses accommodate even advanced corneal steepening without putting pressure on the weakened tissue, making them suitable for patients across the spectrum of disease severity.
For patients with severe dry eye from conditions like Sjogren 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.
- Aqueous-deficient dry eye from autoimmune conditions or medications
- Evaporative dry eye resistant to conventional treatments
- Exposure keratopathy from incomplete eyelid closure
- Neuropathic corneal pain where surface protection promotes healing
Patients who have had corneal transplants (keratoplasty), complications from refractive surgery like LASIK or radial keratotomy, 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.
The lenses can be fitted after healing is complete, typically three to six months post-surgery for transplants or once medically cleared following corneal cross-linking procedures. They provide excellent optical rehabilitation without placing stress on surgical sites or graft-host junctions.
Inherited conditions like Fuchs Dystrophy or acquired degenerations 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.
Conditions including corneal scarring from infections, chemical burns, or inflammatory diseases also benefit from the protective environment scleral lenses create. The constant hydration and mechanical shielding support corneal health while improving functional vision.
Both corneal and lenticular astigmatism can be effectively corrected with scleral lenses. The rigid optical surface neutralizes irregular astigmatism that cannot be corrected with spectacles, while custom toric designs address residual cylindrical errors for even sharper vision.
- High regular astigmatism exceeding typical soft toric lens ranges
- Irregular astigmatism from trauma or previous surgery
- Unstable vision with soft toric lenses due to rotation issues
Evaluation and Diagnostic Process
Determining candidacy for scleral lenses requires thorough evaluation beyond a standard eye exam. Our specialty lens team uses advanced diagnostic tools to assess whether these lenses are appropriate and to gather the measurements needed for successful fitting.
The evaluation begins with a complete eye examination to assess overall ocular health, measure visual acuity, and identify any contraindications to contact lens wear. This includes checking for active eye infections, uncontrolled inflammation, or other conditions that would require treatment before lens fitting.
We also review your medical history, current medications, previous contact lens experience, and specific visual needs. Understanding your daily activities, work requirements, and lifestyle helps our eye doctors determine if scleral lenses will meet your functional goals.
Corneal topography creates detailed three-dimensional maps of your corneal shape, revealing irregularities not visible during standard examination. This technology measures thousands of data points across the corneal surface to guide initial lens selection and design.
- Topography maps identify areas of steepening, flattening, or irregular curvature
- Optical coherence tomography measures corneal thickness and evaluates the anterior chamber
- Scleral mapping technology captures the unique contours of the white part of your eye
- Measurements guide customization of lens diameter, curvature, and landing zone design
Diagnostic trial lenses allow our eye doctors to assess how different lens parameters perform on your eyes. Using fluorescein dye under specialized lighting, we evaluate corneal clearance, lens centration, edge alignment, and comfort to refine the prescription.
This process often requires multiple trial lenses during the initial fitting and subsequent visits to fine-tune the design. Patients try the lenses for extended periods to ensure adequate comfort and vision throughout typical daily wear, with adjustments made based on performance and feedback.
Qualities of an Ideal Candidate
While scleral lenses can help many people with complex eye conditions, a successful experience depends on a patient's personal circumstances, motivation, and commitment to proper care. Understanding these factors helps set realistic expectations.
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.
The learning curve typically spans one to three weeks, during which handling becomes more efficient and comfortable. Most patients master the insertion technique within several days of practice, though some require additional coaching and support from our specialty lens team.
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 using only approved solutions.
- Daily cleaning after each removal using preservative-free saline and approved cleaners
- Overnight disinfection in hydrogen peroxide-based systems or approved multipurpose solutions
- Regular replacement of lens cases every one to three months
- Avoiding all water exposure including tap water, swimming pools, and hot tubs
- Maintaining adequate supplies of solutions and having backup lenses available
While scleral lenses often provide dramatic vision improvement, they may not restore perfect 20/20 vision in every case, especially with advanced corneal disease or scarring. Successful candidates understand their likely outcomes and are satisfied with significant functional improvement.
Our eye doctors discuss anticipated vision levels during the consultation based on your specific condition and diagnostic findings. For most patients, scleral lenses provide the best possible vision correction short of surgical intervention like corneal transplantation.
Because these lenses are larger, handling them requires steady hands and coordination. Ideal candidates are comfortable touching the area around their eyes and can manage the insertion and removal process, though specialized insertion tools and plungers are available to assist.
Patients with arthritis, tremor, or limited hand mobility may need family assistance or adaptive devices. Our team provides training to both patients and caregivers to ensure successful lens management, and most people can achieve proficiency regardless of initial concerns.
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.
- Initial dispensing visit to learn insertion, removal, and care procedures
- Follow-up within one week to assess comfort and initial adaptation
- Additional visits as needed to optimize lens parameters
- Routine monitoring every six to twelve months once stable
Benefits and Important Considerations
Scleral lenses offer unique advantages for patients with complex vision needs, but they also come with important responsibilities and considerations that patients should understand before beginning 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 compared to previous correction methods.
Clinical studies show that patients with keratoconus and other irregular corneas achieve significantly better visual acuity with scleral lenses than with spectacles or soft contact lenses. The stable optics remain consistent even during vigorous physical activity or sports.
The constant hydration soothes dry, irritated, or damaged corneas. Most patients can wear their lenses comfortably throughout their entire waking day, a significant improvement over other lens types that may have been intolerable due to dryness or irritation.
- Reduced awareness of blinking throughout the day
- Protection from environmental irritants like wind, dust, and air conditioning
- Stable vision without the fluctuations common with dry eyes
- Typical comfortable wearing time of twelve to sixteen hours daily
The lens shields the cornea from environmental irritants and mechanical trauma from blinking. For patients with surface disease, injury, or post-surgical healing needs, this protection can promote corneal repair while maintaining functional vision during recovery.
Research demonstrates that scleral lenses successfully heal refractory corneal epithelial defects through their liquid bandage effect. The mechanical barrier prevents eyelid friction over damaged areas, allowing natural healing processes to progress more effectively.
Scleral lenses are custom medical devices that require specialized fitting expertise and multiple visits. The initial investment includes professional fitting fees and the cost of custom-manufactured lenses, which is higher than standard contact lenses but often covered by medical insurance for qualifying conditions.
Ongoing costs include specialized cleaning solutions, regular lens replacement typically every one to two years depending on wear patterns, and periodic follow-up examinations. Patients should maintain backup spectacles and consider purchasing spare lenses to avoid disruption if a lens is damaged or lost.
Most patients notice immediate vision improvement, but full comfort adaptation typically requires several days to two weeks of consistent wear. Initial awareness of the lens edge or sensation of fluid movement is normal and usually resolves as you adjust.
- Gradual increase in wearing time during the first week
- Learning efficient insertion technique with practice and patience
- Avoiding water exposure during wear requires lifestyle modifications
- Carrying necessary supplies when away from home
Self-Care and Maintenance Guidelines
Proper daily care and maintenance are essential for safe, comfortable, and successful scleral lens wear. Following recommended protocols protects your eye health and extends the life of your custom lenses.
Clean your lenses immediately after removal each day. Rinse thoroughly with preservative-free saline, then apply a few drops of approved cleaning solution to each lens surface and gently rub with your fingertip for ten to fifteen seconds per side to remove deposits and debris.
Rinse again with fresh preservative-free saline before placing in your storage case filled with fresh disinfecting solution. Never reuse solution or top off partially used solution in your case, as this significantly increases infection risk.
Use only hydrogen peroxide-based disinfection systems or approved multipurpose solutions specifically recommended for your lenses. Most practitioners prefer hydrogen peroxide systems for their superior disinfection and protein removal capabilities with scleral lenses.
- Fill case with fresh solution before placing lenses in designated holders
- Allow minimum six-hour soak time for complete hydrogen peroxide neutralization
- Never insert lenses before neutralization is complete to avoid severe irritation
- Replace lens case every one to three months or per manufacturer recommendations
Remove your lenses immediately if you experience significant pain, sudden vision decrease, intense redness, discharge, or extreme light sensitivity. These symptoms may indicate serious complications requiring prompt evaluation by our eye doctors at ReFocus Eye Health Manchester.
Contact our office right away rather than trying to troubleshoot on your own. Early intervention prevents minor issues from becoming serious problems. Never continue wearing lenses if you suspect an eye infection, corneal abrasion, or other injury.
Frequently Asked Questions
Here are answers to common questions patients ask about scleral lens candidacy and what to expect from the fitting and wearing experience.
Children with progressive keratoconus or severe dry eye may benefit significantly from scleral lenses when other options fail. Success depends on the child's maturity, ability to handle the lenses responsibly, and strong parental involvement for cleaning, maintenance, and ensuring compliance with care routines and follow-up appointments.
The fitting process typically spans four to eight weeks from initial evaluation to final lens dispensing and requires three to five office visits. Complex cases or patients needing significant design modifications may require additional time and appointments to achieve optimal results. Once stable, routine monitoring visits occur every six to twelve months.
Many medical insurance plans cover scleral lenses when deemed medically necessary for conditions like keratoconus, corneal transplant, severe dry eye, or post-surgical complications. Coverage varies widely by plan and diagnosis. Our office staff will verify your benefits, provide detailed documentation of medical necessity, and submit for prior authorization to help maximize your insurance coverage.
Regular follow-up visits monitor your eye health and vision changes over time. If your prescription changes significantly or your corneal shape progresses, our eye doctors can modify or reorder your lenses with updated parameters. For progressive conditions like keratoconus, periodic refitting may be necessary as the disease evolves, especially during teenage and young adult years.
Most patients with well-controlled glaucoma can safely wear scleral lenses. You must inform your specialty lens fitter about your diagnosis and all glaucoma medications so proper monitoring can be implemented. Our eye doctors will assess your eye pressure during fitting visits and coordinate with your glaucoma specialist to ensure the lens fit does not interfere with your disease management.
Pack all necessary supplies including cleaning solution, disinfecting solution, preservative-free saline for insertion, your lens case, backup lenses if available, and current prescription glasses. Carry solutions in acceptable containers for air travel security. Consider bringing extra supplies in case of travel delays, and never compromise hygiene practices even when away from home.
Getting Help for Vision Challenges
Many patients with complex corneal conditions or chronic eye surface problems find that scleral lenses significantly improve both their vision and quality of life. If you are struggling with vision challenges that have not been successfully managed with glasses or standard contact lenses, a comprehensive evaluation can determine whether specialty lens options might help restore clearer, more comfortable vision.
Very helpful and made sure I had the professional help and support needed even after hours. Thank you again to the team at ReFocus Eye Health
Eric Campbell
Wonderful…Dr. was very helpful, knowledgeable and patient. My wife and I were very pleased.
Angelo Gesmundo
Wonderful friendly group. Dr. Goldstein is the best. I recommend him highly.
Donna Graugard
Everyone in the office is always pleasant. First time appointment with Dr CAVANAUGH at ReFocus Eye Health positive experience.
BlurryApple 76
Very nice! Front office was friendly and professional. Did not have to wait long for the doctor. I was nervous at first, but was made at ease by all. Will be seeing them all again soon.
Barbara Estabrook
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