Scleral lenses have changed the way we approach complex corneal and ocular surface conditions. These lenses are built on precision and advanced imaging to create a custom solution for each patient. Using high-resolution anterior segment optical coherence tomography (AS-OCT), we can measure the exact shape and depth of your eye. This helps ensure a comfortable fit and the best possible vision.
Anterior segment OCT is a high-resolution, non-contact imaging tool that creates detailed cross-sectional views of the front part of your eye. Unlike traditional topography, which shows only the curvature of your cornea, OCT measures the true sagittal height. This is the vertical distance from a defined line to the highest point of your cornea. Because scleral lenses vault over the cornea and rest on the white part of your eye (the sclera), this precise depth measurement is essential for achieving the right fit.
Sagittal height is measured using a specific chord length on the surface of your eye, such as 10 mm or 15 mm. This measurement tells us how much clearance will exist between the lens and your cornea. This space is called the central vault. If the clearance is too small, the lens may press against your cornea and cause discomfort. If the clearance is too large, the lens may feel unstable. AS-OCT captures these small measurements with great accuracy, allowing our optometrists to match the lens design to your unique eye shape.
Unlike regular contact lenses that sit directly on the cornea, scleral lenses vault over the entire corneal surface. This makes accurate measurement of sagittal height critical. Knowing the vertical profile of your eye helps ensure the ideal fit, which maximizes comfort and reduces the risk of complications. By addressing the vertical dimension of the eye, we can design a lens that avoids problems such as corneal touch or excessive edge lift.
With AS-OCT, we can see and measure the space between the back of the lens and your cornea. An initial vault target of 200 to 300 microns is typically established. This ensures the lens does not press on your cornea, which helps reduce irritation and potential problems.
The limbus is the border between your cornea and the white of your eye. It contains delicate stem cells that are important for corneal health. AS-OCT measurements help us make sure there is enough clearance around this area. This protects these cells from mechanical trauma and low oxygen conditions that can result from a poor lens fit.
AS-OCT imaging allows us to check how the outer edges of the scleral lens align with your sclera. Detecting issues like excessive edge lift, blanching of the conjunctiva, or localized pressure ensures the lens fits well and remains comfortable and stable during wear.
The precise data from OCT directly informs which diagnostic lens to start with. It can also be used to customize a lens design through specialized software. This tailored approach helps reduce the number of fitting visits needed to achieve the best configuration for your eyes.
By capturing a series of OCT scans over time, we can track how the lens settles. Scleral lenses often show a reduction of 100 to 150 microns after initial wear. Regular monitoring allows for adjustments to maintain consistent clearance and comfort.
Before selecting or fitting any lens, we perform a comprehensive imaging session. AS-OCT captures sagittal profiles at different chord lengths, such as 10 mm and 15 mm. These initial measurements provide important baseline data that guide the lens selection process. This ensures the lens design works well with the unique shape of your eye.
With OCT data in hand, we can make an informed decision about the starting lens parameters. Using the precise measurements of your eye's sagittal height, our optometrists select an appropriate diagnostic lens. If needed, the data can also be entered into lens design software to refine the initial parameters for a closer match to your anatomy.
Once the lens is placed on your eye, it is important to reassess using OCT after the lens has settled. This usually happens between 30 and 60 minutes after application. During this time, the lens may settle slightly. The OCT images capture this new, stabilized configuration. This scan verifies the central vault, limbal clearance, and how well the lens meets the sclera.
Based on the post-application OCT imaging, adjustments to the lens design may be needed. Whether changing the vault height or refining the edge alignment, every modification is guided by the detailed images from OCT. After adjustments are made, a final scan confirms that the lens meets the desired criteria for long-term comfort and clear vision.
Eyes that have undergone corneal surgery or those with unusual shapes benefit greatly from OCT imaging. Traditional mapping methods can fall short in these cases. OCT captures subtle asymmetries and elevation differences, allowing us to design a lens that fits even the most irregular corneal surfaces with precision.
Not every patient is an ideal candidate for scleral lenses. Sometimes a hybrid lens may be a better option. OCT data allows us to compare scleral and hybrid lens fits in borderline cases. This information helps ensure the most appropriate choice for your comfort and visual clarity.
For patients who may need future corneal surgery, baseline OCT imaging provides an important reference point. By documenting your eye's initial state and how it adapts to scleral lens wear, we create a detailed record. This documentation is valuable when planning any future surgical treatments.
One of the key strengths of using AS-OCT is the ability to create a customized fit for each patient. Every eye is unique, and traditional measurements sometimes have limits that can lead to longer adjustment periods. With AS-OCT, measurements are highly accurate, tailoring each lens to your eye's specific features. This personalized approach is especially important for patients with unusual corneal shapes.
By focusing on precise measurements and advanced imaging, we can reduce the risk of complications with scleral lens wear. Ensuring adequate limbal clearance protects your ocular surface health by avoiding mechanical trauma and low oxygen conditions. Proper assessment of edge alignment helps reduce issues such as redness or localized pressure, contributing to a more comfortable lens experience.
The efficiency gains from AS-OCT are significant. Traditional scleral lens fitting required multiple visits and extensive trial periods. Now, with high-resolution imaging providing accurate and immediate data, the overall process is faster. We can quickly determine the best initial lens design and reliably predict how the lens will perform. This means you receive a well-fitted lens sooner, reducing inconvenience and improving satisfaction.
Scleral lenses may settle slightly after initial application, typically showing a reduction in central vault by 100 to 150 microns. With OCT, these changes can be monitored precisely. This tracking is important not only for immediate adjustments but also for understanding how the lens interacts with your eye over time. Regular assessments ensure that any significant changes are caught early, keeping the lens stable and comfortable.
As part of long-term eye care, your eye's shape may change due to aging, minor fluctuations in corneal curvature, or surgical procedures. The detailed imaging from AS-OCT gives us reliable data to re-evaluate and adjust your scleral lens parameters as needed. This ongoing adaptability helps prevent complications while ensuring you continue to enjoy optimal lens alignment and clear vision.
At Insight Vision Center Optometry, our fitting process uses the Tomey WaveDyn Aberrometer and AS-OCT to capture detailed measurements of each patient's eye. These tools allow for wavefront-guided custom scleral lens designs that address higher-order aberrations, which are optical imperfections that standard lenses cannot correct. This technology is particularly beneficial for patients with keratoconus, post-surgical corneas, or severe astigmatism.
Dr. Nathan Schramm, OD, FSLS, FBCLA holds fellowships in both scleral lenses (FSLS) and contact lenses (FBCLA). He is the principal investigator in the WaveDyn wavefront-guided scleral lens study and co-founded the International Congress of Scleral Contacts. Dr. Thanh Mai, OD, FSLS, FIAOMC also holds an FSLS fellowship and uses Pentacam corneal tomography to support complex contact lens fittings.
Our contact lens team works with patients who have a wide range of conditions, including:
Initial fitting appointments typically take one to two hours. This includes the imaging session, diagnostic lens trial, and time for the lens to settle before final measurements. Follow-up visits are usually shorter, around 30 to 45 minutes.
Most patients find scleral lenses very comfortable once they are properly fitted. Because the lens vaults over the cornea and rests on the less sensitive sclera, many patients report that scleral lenses feel more comfortable than smaller contact lenses. The fluid reservoir under the lens also provides continuous hydration.
After the initial fitting, you will typically return for a follow-up visit within one to two weeks. Additional visits may be scheduled as needed to fine-tune the fit. Once your lenses are stable, annual check-ups are usually recommended to monitor your eye health and lens performance.
Yes. Scleral lenses can correct higher-order aberrations that glasses and standard contact lenses cannot address. For patients with irregular corneas, such as those with keratoconus or post-surgical complications, scleral lenses often provide clearer vision than any other option.
Scleral lenses require daily cleaning with an approved lens solution. You will also use a preservative-free saline solution to fill the lens before insertion. We will provide detailed instructions on proper cleaning, storage, and handling to keep your lenses in good condition and your eyes healthy.
Standard scleral lenses correct basic refractive errors like nearsightedness, farsightedness, and regular astigmatism. Wavefront-guided scleral lenses go further by measuring and correcting higher-order aberrations. These are subtle optical imperfections that can cause glare, halos, or reduced contrast. Wavefront-guided lenses are custom-designed based on detailed measurements of your eye's unique optical system.
