Scleral Lenses

Have you been told you are NOT a suitable candidate for contact lenses? Or, have you tried various contact lenses without success due to poor comfort or quality of vision? If so, then you should consider discussing scleral gas permeable (GP) contact lenses as an option with your eyecare provider. These larger diameter GP contact lenses, commonly referred to as “scleral” lenses, are custom designed to completely vault over the corneal surface and rest gently upon the clear conjunctiva overlying the sclera (i.e. the white of the eye).¹ In doing so, they may offer more stability than conventional, small diameter, corneal GP lenses, resulting in improved lens comfort while maintaining a high level of durability and exceptional vision for most patients. They also have a variety of purposes for regular and irregular corneas, post-surgical eyes, and ocular surface disease (i.e. dry eye disease) patients.² This means YOU may be a suitable contact lens candidate after all!

Scleral Lens Basics

As the name suggests, scleral lenses are designed to vault over the cornea and land gently upon the soft and translucent conjunctival tissue, which overlies the sclera. There are three lens zones (optic, transition, and landing) that your eyecare provider can modify to optimize your lens comfort, ocular health, and vision.³ A sterile, non-preserved saline solution is used to fill the bowl of the scleral lens prior to lens insertion. This forms a fluid-filled reservoir between the lens back surface and corneal front surface. Scleral lenses are designed with highly oxygen permeable materials to ensure a safe and healthy wearing experience. Additional lens coatings may be applied to enhance lens wetting and comfort. Lastly, unique instructions for lens application and removal will be taught to you by your eye care provider to ensure an enjoyable and safe lens wearing experience.

Types of Scleral Lenses

Depending upon the shape of your eye, your eye care provider may use a particular scleral lens design to improve your lens fit, comfort, and vision. While some patients are fit with lenses that are perfectly round at the lens edge (i.e., spherical), many patients will benefit from a lens design that has a non-uniform lens edge (i.e., toric, quadrant-specific, or full-customized). In fact, it is estimated that only about 6% of eyes have a primarily spherical shape where the scleral lens lands upon the eye’s surface.⁴ Your eye care provider may use an imaging platform, an eye impression mold, or simply place a diagnostic scleral lens on your eye to determine which lens type is best suited for you.³

Patients that rely upon multifocal optics in their glasses for near and intermediate tasks (i.e. bifocal or progressive lenses) but wish only to wear contact lenses may ask their eye care provider about “multifocal” scleral lens optics. This design allows patients to see and function at most all visual distances. In fact, comparison with single-vision optics (i.e. correct for one distance only) may reveal better vision at both near and intermediate distances without compromise to far vision in normal light settings.⁵

Challenging Contact Lens Patients?

Scleral lenses may be used for both optical (i.e. vision-related) or therapeutic (i.e. health-related) purposes.³ Some patients have unique corneal or ocular surface circumstances that make them better scleral lens candidates when compared to available soft or conventional corneal GP lenses choices. In fact, it has been shown that the use of scleral lenses for visual rehabilitation in some stable eye conditions was sufficient to delay the need for eye surgery.⁶ A non-exhaustive list of patients that may benefit from scleral lenses includes irregular or scarred corneas, post-surgical eyes, and severe dry eye patients.^2,7

• Irregular corneas. Whether corneal irregularities or scarring occur from natural conditions such as keratoconus, following eye surgery (ex. LASIK/PRK, corneal transplantation), or other circumstances, these eyes often suffer from reduced vision.⁷ In cases where spectacle or soft contact lenses cannot improve vision to a satisfactory level, scleral lenses may be an excellent option.⁷
• Hard to fit eyes. Some patients have difficulty adapting to conventional corneal GP lenses or experience lens dislodgement due to the shape of their eyes (during sporting activities, for example). Scleral lenses may offer improved lens comfort and stability without compromising vision.
• Dry Eye Patients. When other soft or GP lens choices are too uncomfortable or severe ocular surface disease requires advanced therapies, scleral lenses may provide both dry eye treatment and vision correction.⁸ The fluid-filled reservoir formed between the scleral lens back surface and corneal front surface provides constant lubrication and enhance comfort during lens wear.

If you wonder whether or not you are a good scleral lens candidate, discuss it directly with your eye care provider.

Cost of Scleral Lenses

Scleral lenses are highly customizable and independently designed with each patient’s eyes in mind to ensure the best possible vision, eye health, and comfort. Depending on the complexity of a particular ocular condition, equipment used during the fitting process, or lens material and modifications required to perfect the lens fit, the cost per lens per patient may vary widely. It is best to discuss the fitting & material fees, replacement fees, and lens warranty period with your eye care provider before starting a scleral lens fitting exam.

In some cases, medical or vision insurance may cover a portion of the costs associated with scleral lenses.

Contributed by: Bradley Salus, OD, FAAO

References

1. Michaud L, Lipson M, Kramer E, Walker M. The official guide to scleral lens terminology. Cont Lens Anterior Eye. 2020;43(6):529-534.
2. Fadel D, Kramer E. Potential contraindications to scleral lens wear. Cont Lens Anterior Eye. 2019;42(1):92-103.
3. Barnett M, Courey C, Fadel D, et al. CLEAR – Scleral lenses. Cont Lens Anterior Eye. 2021;44(2):270-288.
4. DeNaeyer G, Sanders D, van der Worp E, Jedlicka J, Michaud L, Morrison S. Qualitative Assessment of Scleral Shape Patterns Using a New Wide Field Ocular Surface Elevation Topographer: The SSSG Study. Journal of Contact Lens Research and Science. 2017;1(1):12-22.
5. Privado-Aroco A, Valdes-Soria G, Romaguera M, Serramito M, Carracedo G. Visual Quality Assessment and Comparison of Monofocal and Multifocal Scleral Lens Designs: A Pilot Study. Eye Contact Lens. 2024;50(1):35-40.
6. DeLoss KS, Fatteh NH, Hood CT. Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral device compared to keratoplasty for the treatment of corneal ectasia. Am J Ophthalmol. 2014;158(5):974-82.
7. Jacobs DS, Carrasquillo KG, Cottrell PD, et al. CLEAR – Medical use of contact lenses. Cont Lens Anterior Eye. 2021;44(2):289-329.
8. Romero-Rangel T, Stavrou P, Cotter J, Rosenthal P, Baltatzis S, Foster CS. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol. 2000;130(1):25-32.