Eye health resource
What Are Scleral Lenses?
Scleral lenses are large-diameter rigid gas-permeable contact lenses that vault the cornea and rest on the sclera. Learn who may benefit and what a specialty fitting involves.
Reviewed for accuracy by Justin Bazan, OD on .
Scleral lenses are large-diameter rigid gas-permeable contact lenses that vault over the cornea and rest on the white part of the eye, called the sclera. Instead of lying directly on most of the cornea, the lens creates a space that is filled with preservative-free saline before insertion.
That design can provide a smooth optical surface over an irregular cornea and can also create a fluid reservoir over the corneal surface. For some patients who have struggled with conventional soft or corneal GP/RGP lenses, a scleral lens can provide a different way to approach vision, fit, and comfort.
How Are Scleral Lenses Different From Regular Contacts?
Most soft contact lenses are smaller and rest across the cornea. Corneal GP/RGP lenses are also smaller than scleral lenses and move more with blinking.
Scleral lenses are larger. Their design is intended to clear the cornea and land farther out on the sclera. Because the fit involves several different zones — central clearance, the area over the limbus, and the landing zone on the sclera — measurements and follow-up are more individualized than a routine soft-lens fitting.
Who May Benefit From Scleral Lenses?
Scleral lenses can be considered for a number of vision and ocular-surface problems, including selected patients with:
- keratoconus or another irregular cornea;
- irregular astigmatism that is not corrected well enough with glasses or standard soft lenses;
- corneal changes after surgery, trauma, or transplantation;
- significant dry-eye or ocular-surface disease in which a fluid reservoir may be helpful; or
- other difficult-to-fit situations where conventional lenses have not provided adequate vision or comfort.
A scleral lens is not automatically the best option for everyone with astigmatism or dry eye. The choice depends on the prescription, corneal shape, ocular surface, eyelids, tear film, handling ability, wearing goals, and how the eye responds during a diagnostic fitting.
Scleral Lenses and Keratoconus
Keratoconus causes the cornea to become thinner and more irregular in shape. Glasses or soft lenses may work well in mild cases, but as the corneal shape becomes more irregular, a rigid optical surface can sometimes provide clearer vision.
Scleral lenses are one specialty option for keratoconus because the lens can vault the irregular cornea while the front surface of the lens provides a more regular refracting surface.
Scleral Lenses and Dry Eye
The preservative-free saline reservoir beneath a scleral lens can protect the corneal surface from direct environmental exposure while the lens is being worn. That can be useful for selected patients with significant ocular-surface disease.
However, dry eye has many causes, and scleral lenses are not a universal dry-eye treatment. Some patients are better served with other therapies, and the health of the ocular surface still needs to be monitored while wearing specialty lenses.
What Does a Scleral Lens Fitting Involve?
A specialty fitting generally includes a recent comprehensive eye exam plus additional measurements of the cornea and ocular surface. At Park Slope Eye, we may use corneal topography and diagnostic lenses to evaluate how a lens clears the cornea, aligns over the eye, centers, settles, and performs visually.
The first lens is not always the final lens. Scleral fitting often requires follow-up visits and design adjustments before the prescription and fit are finalized.
Are Scleral Lenses Comfortable?
Many patients are pleasantly surprised by scleral-lens comfort because the lens lands on the sclera rather than moving across the sensitive cornea with every blink. But comfort is individual, and a large lens can still feel unfamiliar at first.
Insertion, removal, filling the lens correctly, cleaning, and avoiding trapped air bubbles are all important parts of successful wear. We teach these steps during the fitting process.
Does Park Slope Eye Fit Scleral Lenses?
Yes. Scleral lenses are part of Park Slope Eye's specialty contact lens fitting services, along with corneal GP/RGP, toric, multifocal, monovision, and Ortho-K lenses.
If conventional contacts have not provided the vision, fit, or comfort you need, book an appointment to discuss whether a specialty fitting may be appropriate.
Originally published . Substantially updated .