Scleral lenses are large-diameter contact lenses designed to vault over the cornea. They offer comfort and clear vision for patients who experience complications after LASIK, PRK, or RK surgery. When glasses or standard soft lenses no longer work well, scleral lenses can help restore sharp, stable vision.
Refractive surgeries like LASIK, PRK, and RK reshape the cornea to correct vision. While these procedures work well for many people, they can sometimes cause lasting changes to the corneal surface. One concern is corneal ectasia, a condition where the cornea becomes weakened and starts to bulge or change shape over time.
Patients with post-surgical complications may notice several vision problems that affect daily life.
Even when the surgery itself was successful, many patients find that glasses or regular soft contact lenses no longer provide clear vision. Traditional lenses sit on the cornea and follow its shape. When the cornea has irregularities, these lenses cannot correct the uneven surface. This often leads to blurry or distorted images.
Scleral lenses work differently than regular contact lenses. Instead of resting on the cornea, they vault over it completely. The lens sits on the sclera, which is the white part of the eye. This design creates a small space between the lens and the cornea.
Before inserting a scleral lens, it is filled with preservative-free saline solution. This creates a fluid-filled chamber that bathes the cornea continuously. The fluid smooths out any surface irregularities and provides constant moisture to the eye.
The combination of the lens and the fluid reservoir creates a smooth, uniform surface for light to pass through. This new optical surface corrects vision problems that the irregular cornea cannot, including higher-order aberrations that glasses cannot fix.
The smooth optical surface neutralizes irregular astigmatism and reduces visual distortions like glare and halos. Many patients achieve better vision with scleral lenses than they could with glasses or standard contacts after refractive surgery.
Scleral lenses distribute their weight across the sclera rather than pressing on the sensitive cornea. The sclera has fewer nerve endings than the cornea, so most patients find scleral lenses very comfortable. Many can wear them all day without irritation.
Because the lens does not touch the cornea, it avoids adding mechanical stress to tissue that may still be healing or has residual weakness. This protection is especially valuable for patients with corneal ectasia or other structural concerns.
The saline reservoir keeps the cornea constantly hydrated throughout the day. This continuous moisture helps relieve dry eye symptoms, which are common after laser vision correction procedures.
Scleral lenses can be customized in many ways. The shape, diameter, optical power, and curvature can all be adjusted to match each patient's unique eye structure and visual needs.
The fitting process begins with a thorough eye exam. At Insight Vision Center Optometry, we use advanced imaging tools like corneal topography and the Pentacam to create detailed maps of the eye surface. These measurements guide the lens design.
One key measurement is the space between the back of the lens and the front of the cornea. This clearance must be enough to maintain a healthy fluid reservoir without putting pressure on the cornea. Too little clearance can cause discomfort, while too much can affect vision stability.
For eyes with severe irregularities, the lens may need a deeper vault or larger diameter. Adjusting these measurements helps the lens clear the entire corneal surface. Dr. Nathan Schramm, OD, FSLS, FBCLA and Dr. Thanh Mai, OD, FSLS, FIAOMC both hold fellowships in scleral lens fitting and use technologies like the Tomey WaveDyn Aberrometer to achieve precise results.
The limbus is the junction where the cornea meets the sclera. The lens design must avoid pressing on this area. Proper limbal clearance prevents irritation and maintains healthy blood flow to the cornea.
LASIK creates a thin flap in the cornea that is lifted during surgery and replaced afterward. Some patients develop dry eye, glare, halos, or residual refractive errors after LASIK. Scleral lenses address these issues without putting pressure on the corneal flap.
PRK removes the outer layer of the cornea entirely, so the surface is more directly affected than in LASIK. The protective fluid reservoir of a scleral lens is especially helpful for PRK patients. It reduces discomfort during healing and creates a smoother optical interface.
RK involves making radial incisions in the cornea. Although this procedure is less common today, many patients who had RK years ago now experience significant corneal irregularities and vision fluctuations. Larger scleral lenses can accommodate these complex shapes and restore stable, clear vision.
Scleral lenses may be a good option if you experience any of the following after refractive surgery.
Most patients wait until the cornea has stabilized after surgery before being fitted for scleral lenses. This usually takes a few months. Waiting allows the eye to heal and any sutures to be removed. We will help determine the right time to begin the fitting process.
Corneal edema is mild swelling of the cornea that can sometimes occur with extended lens wear. In healthy eyes, this is usually minimal. However, patients with post-surgical corneas may be more susceptible. Using high oxygen-permeable lens materials and limiting initial wear time helps reduce this risk.
To keep eyes healthy, several precautions are taken during the fitting process.
Contact us if you notice sudden vision changes, increased redness, pain, or discharge while wearing your lenses. Early attention to any concerns helps prevent complications and keeps your eyes healthy.
Scleral lenses require a specific technique for insertion and removal. You will fill the lens bowl with preservative-free saline before placing it on your eye. Removal involves breaking the suction seal gently using your fingertips or a small plunger tool. We will teach you these steps and watch you practice until you feel confident.
Proper cleaning is essential for safe lens wear. You will use recommended solutions to clean and disinfect your lenses daily. Always wash your hands thoroughly before handling your lenses. Store them in fresh solution each night.
Most patients start by wearing their lenses for just a few hours each day. Over several weeks, wear time gradually increases as the eyes adjust. This gradual approach helps ensure comfort and allows us to monitor how your eyes respond.
Ongoing monitoring is important for long-term success. Regular check-ups allow us to evaluate corneal health, check the lens fit, and make any needed adjustments. Most patients notice steady improvement in vision and comfort as they adapt to their new lenses.
Most patients adapt to scleral lenses within one to two weeks. The first few days may feel different as your eyes adjust to the new sensation. Gradually increasing wear time helps your eyes build tolerance. Many patients find scleral lenses more comfortable than other contact lens types once they complete the adjustment period.
Many patients wear scleral lenses comfortably for 12 to 16 hours daily once fully adapted. We will recommend a wear schedule based on your individual situation. Some patients with certain corneal conditions may need to limit wear time or remove lenses midday to refresh the fluid reservoir.
Scleral lenses are made from durable materials and typically last one to two years with proper care. We will examine your lenses at follow-up visits and recommend replacement when needed. Changes in your prescription or eye shape may also require new lenses.
Coverage varies by insurance plan and individual circumstances. Some medical insurance plans cover medically necessary contact lenses for conditions like corneal ectasia or post-surgical complications. Our eye care team can help you understand your coverage options and provide documentation if needed.
Scleral lenses often provide better vision than glasses or standard contacts for patients with irregular corneas. Many patients achieve 20/20 vision or close to it. However, results depend on individual factors including the degree of corneal irregularity and overall eye health.
Fogging can occur when debris or proteins accumulate in the fluid reservoir. If this happens, you may need to remove the lens, clean it, and reapply with fresh saline. Some patients benefit from using specific filling solutions or lens coatings that reduce fogging. We can recommend solutions based on your experience.
