Scleral lenses are specialized contact lenses designed for people whose vision cannot be adequately corrected with glasses or standard contacts. These large-diameter lenses vault over the cornea (the clear front surface of your eye) and rest on the sclera (the white part), creating a fluid-filled chamber that can transform vision and comfort for patients across Orange County with complex eye conditions.
Scleral lenses represent an advanced approach to vision correction that works fundamentally differently than conventional contact lenses. Their unique design and custom fabrication make them particularly effective for eyes that other lenses cannot help.
These lenses create a smooth optical surface by vaulting completely over your cornea and holding a reservoir of preservative-free saline solution between the lens and your eye. This liquid cushion masks irregularities on the corneal surface, corrects vision distortions, and provides continuous hydration that protects your eye from friction and dryness throughout the day.
Standard soft contact lenses drape directly over the cornea, while smaller rigid gas permeable (RGP) lenses rest on the corneal surface. Scleral lenses are much larger and vault completely over the cornea without making contact with it. Because the sclera has fewer nerve endings than the cornea, this design often provides superior comfort, especially for sensitive or irregularly shaped eyes.
Every scleral lens is individually designed based on detailed measurements and three-dimensional mapping of your eye's unique topography. We use advanced diagnostic technology including the Tomey WaveDyn Aberrometer and anterior segment OCT imaging to capture the precise contours of your eye. For patients with highly irregular corneas, we may use EyePrintPRO, which creates an actual impression of your eye to design a perfectly matched lens. The fitting process requires multiple visits to ensure optimal vision, comfort, and long-term eye health.
Scleral lenses can be life-changing for patients with various corneal diseases and ocular surface conditions. These specialized lenses often restore functional vision when other treatment options have not been successful.
Keratoconus causes the cornea to thin progressively and bulge into an irregular cone shape, resulting in distorted and blurry vision that glasses cannot adequately correct. Scleral lenses vault over this irregular surface and create a perfectly smooth optical interface with the saline reservoir, often providing dramatically clearer and more stable vision than any other non-surgical option.
Patients with severe dry eye from conditions like Sjogren syndrome, graft-versus-host disease, or autoimmune disorders often experience constant burning, grittiness, and light sensitivity. The fluid reservoir beneath a scleral lens acts as a liquid bandage, bathing the cornea in preservative-free moisture throughout the day and providing significant symptom relief.
Eyes that have undergone corneal transplant surgery, experienced complications from LASIK or other refractive procedures, or sustained traumatic injury may be left with an uneven corneal surface. Scleral lenses bypass these irregularities by creating a new front optical surface, often restoring clear, functional vision when other correction methods have failed.
Inherited conditions like pellucid marginal degeneration, Fuchs dystrophy, and other corneal abnormalities can affect both the shape and clarity of the cornea. By creating a smooth refractive surface over the irregular cornea, scleral lenses can improve vision quality and may help delay the need for surgical intervention in some cases.
Neurotrophic keratitis develops when corneal nerves are damaged, reducing sensation and impairing your eye's natural ability to heal itself. The protective fluid layer maintained under a scleral lens shields the vulnerable cornea from environmental exposure and friction, promoting healing while preventing further damage.
Autoimmune conditions like Stevens-Johnson syndrome or ocular cicatricial pemphigoid can cause extensive scarring of the eye surface. Scleral lenses serve as a prosthetic shield, improving both comfort and vision while protecting the remaining healthy tissue from additional damage caused by blinking and environmental irritants.
While scleral lenses can help many patients, successful long-term wear depends on personal commitment and realistic expectations. Certain qualities and circumstances increase the likelihood of a positive outcome.
Inserting and removing scleral lenses requires learning a specific technique that differs from standard contact lens wear. Ideal candidates are patient during the learning process and motivated to master the proper handling methods, which typically takes a few practice sessions under our guidance.
Proper cleaning and disinfection are essential to prevent serious eye infections. Good candidates understand the importance of following all care instructions precisely and are willing to invest time each day in proper lens maintenance, including using only recommended solutions and never exposing lenses to tap water.
While many patients experience dramatic vision improvement with scleral lenses, results vary based on the underlying condition and degree of corneal damage. Successful candidates understand that the goal may be significant functional improvement rather than perfect vision, and they value quality-of-life gains even if some visual limitations remain.
Because scleral lenses are larger than standard contacts, handling them requires reasonably steady hands and the ability to coordinate lens insertion. Most patients adapt well, and assistive tools like plungers and insertion stands are available to help, but candidates should be comfortable with the physical process of lens handling.
Successful scleral lens wear requires ongoing monitoring to ensure the fit remains optimal and your eyes stay healthy. Ideal candidates are committed to attending all scheduled follow-up appointments, which are especially frequent during the initial fitting period, and are willing to return for adjustments when needed.
Scleral lenses offer distinct advantages for patients with complex eye conditions, but they also require greater investment and care compared to conventional lenses. Understanding both the benefits and responsibilities helps set appropriate expectations.
The fluid-filled chamber beneath a scleral lens neutralizes corneal irregularities more effectively than any other non-surgical vision correction option. Many patients experience the clearest, sharpest vision they have had in years, with reduced glare, improved contrast sensitivity, and stable vision throughout the day.
The constant hydration from the saline reservoir soothes dry, damaged, or irritated corneas. Most patients who could not tolerate other types of contact lenses find scleral lenses comfortable enough to wear all day, which can significantly improve daily function and quality of life.
The lens acts as a barrier against environmental irritants including wind, dust, smoke, and dry air. For patients with corneal disease, injury, or post-surgical healing, this protective environment can promote recovery while simultaneously providing functional vision.
Scleral lenses are custom medical devices that require specialized fitting and fabrication. The initial investment includes comprehensive evaluation, fitting fees, and the cost of custom lens manufacturing. Ongoing expenses include specialized cleaning solutions and periodic lens replacement, typically every one to two years depending on wear patterns and lens condition.
Successful outcomes depend heavily on the skill and experience of the eye care provider. Our optometrists, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS, FIAOMC, both hold fellowships in the Scleral Lens Education Society, placing them among approximately 300 practitioners worldwide with this advanced credential. This expertise is essential for managing the complex fitting process and addressing any complications that may arise. Patients considering scleral lenses often have questions about what to expect from the process and how these lenses will fit into their daily lives.
Children with conditions like keratoconus, corneal transplants, or severe dry eye can benefit significantly from scleral lenses, particularly when other vision correction methods are inadequate. Success depends on the child's maturity level, ability to follow handling instructions, and consistent parental involvement in the cleaning and care routine. We evaluate each young patient individually to determine readiness and work closely with families throughout the adaptation process.
Most patients notice immediate improvement in vision clarity when they first insert scleral lenses. Physical adaptation to the sensation of wearing the lenses typically takes anywhere from a few days to two weeks of consistent wear. Initial awareness of the lens edge or feeling of fullness is normal and usually fades as your eyes adjust. We provide close support during this period and make any needed adjustments to optimize comfort.
Each evening after removal, lenses must be rubbed clean with an approved cleaner to remove protein deposits and debris, then rinsed thoroughly with preservative-free saline. Lenses are then stored overnight in a fresh disinfecting solution, most commonly a hydrogen peroxide-based system that neutralizes before morning insertion. Each morning, lenses are filled with fresh preservative-free saline before insertion. It is critical to never use tap water, which can harbor dangerous microorganisms that cause serious eye infections.
If you develop significant pain, redness, light sensitivity, or sudden vision changes while wearing your lenses, remove them immediately and inspect for debris, damage, or deposits. Rinse the lens thoroughly with preservative-free saline and examine your eye in a mirror. If symptoms persist after reinsertion or if you see any redness or discharge, contact our office right away, as these may be signs of an infection or fitting problem that requires prompt attention.
No, scleral lenses are designed for daily wear only and must be removed before sleeping. Overnight wear significantly reduces oxygen flow to the cornea and dramatically increases the risk of serious complications including microbial keratitis, corneal swelling, and blood vessel growth into the cornea. Always remove your lenses before bed and give your eyes time to breathe.
Coverage varies considerably depending on your specific insurance plan and medical diagnosis. Many medical insurance plans, including Medicare, will cover scleral lenses when they are deemed medically necessary for conditions like keratoconus, corneal transplant, severe dry eye, or corneal scarring. Vision insurance typically does not cover specialty medical lenses. Our staff can verify your benefits, provide detailed cost estimates, and assist with prior authorization submissions to help you understand your financial responsibility before beginning treatment.
If you are struggling with vision problems or eye discomfort from a complex corneal condition and believe scleral lenses might help, we encourage you to schedule a consultation at Insight Vision Center Optometry.
Our fellowship-trained optometrists have advanced expertise in custom scleral lens fitting and access to the latest diagnostic and lens design technologies. We will perform a thorough evaluation to determine if you are a candidate and guide you through every step of the fitting process with personalized care.
