Scleral Contact Lenses

What is a scleral lens?

Scleral contacts are large diameter, gas permeable lenses that are designed to vault over the entire cornea (the clear covering of the front of the eye) and rest on the sclera (white part of eye).  This allows them to essentially replace the corneal surface with a perfectly smooth optical surface making them a perfect option for people with irregular corneas.  In addition, the vaulted space between the cornea and the contact lens is filled with artificial tears or non-preserved saline which acts as a fluid reservoir which can provide comfort to people with severe dry eyes who otherwise could not tolerate contact lenses.

Conditions Treated by Scleral Lenses

Scleral lenses can be used to treat the typical causes of blurred vision but are most often used in the correction of irregular corneas due to a variety of conditions.  These may include:

  • Keratoconus

  • Post-Operative Corneal Transplant

  • Pellucid's Marginal Degeneration

  • Severe Dry Eye Disease

    • Sjogren's Syndrome​

    • Graft-vs-Host Disease (GVHD)

    • Stevens-Johnson Syndrome

  • Corneal Scarring

 

The list of conditions treated with scleral lenses continues to grow with improvements in lens designs and technology.

Why Scleral Contacts?

There are several advantages of scleral contact lenses over traditional small diameter gas permeable lenses. 

 

  • Comfort: RGPs rest on the cornea, the most sensitive tissue of the eye.  As the eye blinks, the lens moves on the eye.  If there is too much movement, discomfort and intolerance to the lens can develop.  Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, they are more comfortable.

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  • Centration:  In cases of early disease or mild irregularity, RGPs may provide adequate vision and comfort. However if the smaller diameter lens does not center properly on the eye or moves excessively with blinking, it will cause discomfort and variable vision.  Switching to a large-diameter lens such as a scleral lens may solve this problem.

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  • Stability: Scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye compared to traditional RGPs.

Fitting Process

Scleral contacts are custom designed for each person so the fitting demands greater expertise and often significantly more time than fitting standard soft or gas permeable lenses.

The process of fitting begins with a consultation with our doctor to determine the underlying problem and its severity, discuss previous treatment efforts and their successes or failures and to review the pros and cons of other potential treatments.  If it is determined that a scleral lens fitting is appropriate, a follow up scleral lens fitting appointment will be scheduled.

At the fitting, the doctor will insert lenses of different sizes and curvatures to determine which initial lens provides the appropriate clearance and stability on your eye.  Your vision will then be checked to determine the correct lens power.  This information will be used to design and manufacture a custom scleral lens for you.

The custom lens will be dispensed to you on a separate visit.  Depending on the complexity of the problem and how the individual eye tolerates the scleral lens, adjustments of the lens parameters may be needed. The entire fitting process can take several visits to determine the optimal lens for each eye.