Understanding Scleral Contact Lenses
Scleral contact lenses are large-diameter gas permeable lenses designed to vault over the entire corneal surface. Unlike traditional contact lenses that rest directly on the cornea, scleral lenses land on the sclera, which is the white outer portion of the eye. This unique design creates a smooth optical surface over an irregular cornea, providing remarkably sharp vision for patients who struggle with standard lenses.
One of the defining features of scleral lenses is the fluid reservoir that forms between the back surface of the lens and the front surface of the cornea. Before insertion, the lens is filled with preservative-free saline solution. This liquid layer remains in place throughout the day, continuously bathing the cornea in moisture. The reservoir provides exceptional comfort and ongoing hydration, making scleral lenses a preferred option for patients with compromised corneal surfaces or chronic dryness.
Standard soft contact lenses drape directly onto the cornea and conform to its shape. While this works well for many patients, those with irregular corneal surfaces often experience poor vision and discomfort with soft lenses. Scleral lenses take a fundamentally different approach by bridging over the cornea entirely and distributing their weight across the less sensitive scleral tissue.
Because scleral lenses are made from rigid gas permeable materials, they maintain their shape on the eye. This creates a uniform refractive surface that corrects vision with precision. The gas permeable material also allows oxygen to pass through to the cornea, supporting long-term eye health during extended daily wear.
The saline-filled space beneath a scleral lens serves multiple important purposes. It acts as a protective cushion that shields the cornea from environmental exposure, lid friction, and mechanical irritation. For patients with conditions that compromise the corneal surface, this barrier can make a meaningful difference in daily comfort.
The fluid reservoir also compensates for corneal irregularities. Light passing through the saline layer and the smooth front surface of the lens is refracted evenly, producing clearer vision than what the irregular cornea alone could achieve. This optical correction principle is one reason scleral lenses deliver such strong visual outcomes for complex prescriptions.
Who Benefits from Scleral Lenses
Keratoconus is a progressive condition in which the cornea thins and bulges into a cone-like shape, distorting vision significantly. According to the National Eye Institute (2023), keratoconus affects 1 in every 2,000 people in the general population. Scleral lenses are one of the most effective non-surgical options for managing this condition because they vault over the cone and replace the irregular surface with a smooth optical front.
Research published in the journal Contact Lens and Anterior Eye (2022) found that scleral lenses improve visual acuity to 20/25 or better in more than 90 percent of keratoconus patients. For many individuals, this level of correction is life-changing, restoring the ability to drive, work, and engage in daily activities with confidence.
Patients with severe dry eye often find that traditional contact lenses worsen their symptoms. The constant saline reservoir beneath a scleral lens keeps the corneal surface hydrated throughout the day, reducing the burning, stinging, and fluctuating vision that characterize chronic dryness. Many dry eye patients who had given up on contact lenses find renewed comfort with scleral designs.
Conditions such as Sjogren's syndrome, graft-versus-host disease, and other autoimmune disorders that significantly reduce tear production can be especially responsive to scleral lens therapy. The protective fluid layer acts as a prosthetic tear system, shielding the cornea from exposure and helping to maintain surface integrity.
Eyes that have undergone corneal transplantation, refractive surgery, or other ocular procedures may develop irregular astigmatism or surface irregularities that standard lenses cannot adequately correct. Scleral lenses provide stable, high-quality vision for these patients by creating a new optical surface independent of the underlying corneal shape.
Because scleral lenses rest on the sclera rather than the cornea, they can be worn comfortably even on eyes with corneal grafts or delicate post-surgical tissue. Your contact lens specialist will evaluate the health of the transplant or surgical site to ensure safe and effective fitting.
Corneal scars resulting from infections, injuries, or chronic inflammation can severely impair vision. Glasses cannot correct the optical distortion caused by scarring, and soft contact lenses tend to conform to the irregular surface rather than masking it. Scleral lenses effectively neutralize these surface irregularities by vaulting over the scarred tissue and providing a clear, smooth refractive surface.
Patients with ocular surface disease, including Stevens-Johnson syndrome and chemical burns, also benefit from the protective environment that scleral lenses create. The continuous saline bath promotes healing and reduces discomfort associated with damaged corneal surfaces.
Good Candidates for Scleral Lenses
Scleral lenses can benefit a wide range of patients. You may be a strong candidate if you have been diagnosed with keratoconus, pellucid marginal degeneration, or other corneal ectasias. Patients who have difficulty achieving satisfactory vision with glasses or soft contact lenses due to irregular astigmatism are also excellent candidates.
- Individuals with keratoconus or other corneal thinning conditions
- Patients with persistent dry eye that limits standard contact lens wear
- Those who have undergone corneal transplant or refractive surgery with residual vision issues
- People with corneal scars or surface irregularities from injury or infection
- Patients who need high-quality vision correction and have not succeeded with other lens types
Successful scleral lens wear requires a commitment to proper lens care and handling. Patients should be comfortable with the insertion and removal process, which involves a learning curve during the initial fitting period. Your care team will provide thorough training and ongoing support to build your confidence.
Scleral lenses are well suited for patients with active lifestyles. They are stable on the eye, resistant to dislodging during physical activity, and provide consistent vision throughout the day. Many patients wear their scleral lenses comfortably for extended hours, making them practical for work, sports, and social activities.
A comprehensive eye examination is the first step in determining whether scleral lenses are appropriate for you. Your provider will assess your corneal health, tear film quality, scleral shape, and overall ocular condition. Certain active eye infections or uncontrolled inflammation may need to be addressed before fitting can begin.
Patients with a history of poor contact lens compliance should discuss their concerns openly with their care team. Scleral lenses require diligent cleaning and storage routines, and your specialist will help you develop habits that support safe, long-term wear.
How Scleral Lenses Work
Scleral lenses are designed with a specific clearance profile that ensures the back surface of the lens does not touch the cornea at any point. This complete vaulting is essential for both comfort and visual performance. The gap between the lens and the cornea is filled with preservative-free saline, creating the therapeutic fluid reservoir that defines scleral lens wear.
Your contact lens specialist carefully calculates the amount of corneal clearance needed based on your individual eye measurements. Too much clearance can cause the lens to feel heavy or create visual distortion, while too little clearance risks corneal contact. Precision in this area is one of the hallmarks of expert scleral lens fitting.
Scleral lenses are manufactured from advanced gas permeable materials that allow oxygen molecules to pass through the lens to the cornea. Adequate oxygen transmission is critical for maintaining corneal health, particularly with larger lens designs that cover a greater surface area.
Modern gas permeable materials used in scleral lenses offer significantly higher oxygen permeability than earlier generations. Your provider selects a material that balances durability, wettability, and oxygen transmission to suit your specific wearing schedule and corneal needs.
The combination of the rigid lens front surface, the saline-filled reservoir, and the patient's natural cornea creates a multi-element optical system. Light enters through the smooth anterior lens surface, passes through the saline layer, and reaches the cornea in a controlled, uniform manner. This system effectively bypasses corneal irregularities that would otherwise scatter light and degrade vision.
For patients with high or irregular astigmatism, this optical arrangement provides correction that is difficult to achieve with any other non-surgical method. The stable position of the lens on the sclera ensures that the optical correction remains centered and consistent, even during blinking and eye movement.
Types of Scleral Lenses
Mini-scleral lenses have a diameter that extends just beyond the corneal limbus onto the sclera. These lenses are smaller than full scleral designs, making them somewhat easier to handle and insert for new wearers. They still vault over the entire cornea and provide the characteristic fluid reservoir, though the reservoir volume is typically smaller.
Mini-scleral lenses are well suited for patients with mild to moderate corneal irregularities and those who prefer a slightly smaller lens profile. They can be an excellent starting point for patients transitioning from smaller gas permeable lenses to scleral designs. Your specialist will determine whether a mini-scleral lens provides adequate coverage and clearance for your condition.
Full scleral lenses have a larger overall diameter, landing further out on the scleral surface. This extended landing zone provides greater stability, a larger fluid reservoir, and more complete corneal coverage. Full scleral designs are often preferred for patients with advanced keratoconus, significant corneal irregularity, or severe dry eye requiring maximum hydration.
The larger size of full scleral lenses allows for more sophisticated fitting adjustments, including toric peripheral curves that align with the unique contour of each patient's sclera. While the handling of full scleral lenses requires slightly more dexterity, most patients adapt quickly with proper training from their care team.
The decision between mini-scleral and full scleral lenses depends on several factors, including the severity of your corneal condition, your tear film characteristics, and the shape of your sclera. Your contact lens specialist at Washington Eye Institute will evaluate all of these variables during the fitting process to recommend the lens design that best matches your needs.
- Mini-scleral lenses may be recommended for milder conditions and patients new to scleral wear
- Full scleral lenses are often preferred for advanced irregularities and maximum corneal protection
- Both designs can be customized with specific optical zones, edge profiles, and peripheral curves
- Your provider may trial both designs to compare comfort and visual outcomes
What to Expect During Fitting and Wear
The fitting process begins with detailed imaging of your eye's surface. Corneal topography maps the curvature and elevation of the cornea, revealing irregularities that need to be vaulted. Scleral topography, when available, captures the shape of the white part of the eye where the lens will rest. These measurements guide the selection of your initial trial lens.
Your care team at our Greenbelt, Rockville, or Cumberland, Maryland locations uses advanced diagnostic instruments to capture these measurements with high precision. Accurate mapping is the foundation of a successful scleral lens fit and helps minimize the number of adjustments needed.
Based on your topography results, your specialist selects a trial lens from an extensive inventory. The trial lens is placed on your eye and evaluated for fit, clearance, and visual performance. Your provider examines the lens with a slit lamp microscope to verify that the corneal vault is appropriate and that the lens edges align smoothly with your scleral surface.
This evaluation may involve multiple trial lenses during a single appointment. Each lens provides valuable information that helps your specialist refine the final prescription. Patience during this process leads to a more comfortable and visually precise outcome.
Scleral lens fitting is an iterative process. After the initial evaluation, a custom lens is ordered based on your measurements and trial lens findings. When the custom lens arrives, you return for a dispensing appointment where fit and vision are reassessed. Fine-tuning adjustments may be made to optimize clearance, comfort, or optical performance.
Most patients require two to four visits to achieve their optimal fit. Your care team will communicate with you throughout this process, ensuring that each adjustment moves you closer to the best possible outcome. Follow-up appointments are scheduled to monitor lens performance over time.
Inserting a scleral lens involves filling the bowl of the lens with preservative-free saline solution and placing it onto the eye using a specialized suction device, commonly referred to as a plunger or insertion tool. You will tilt your head forward, look down into the lens, and bring it straight onto the eye. This technique helps prevent air bubbles from becoming trapped beneath the lens.
Removal also uses a small suction plunger designed for this purpose. You gently press the plunger onto the lower edge of the lens, break the seal, and lift the lens away from the eye. Your care team will demonstrate these techniques during your fitting appointments and provide hands-on coaching until you feel comfortable performing them independently.
Proper lens care is essential for safe, comfortable scleral lens wear. Each evening after removal, lenses should be cleaned with an approved cleaning solution, rinsed thoroughly, and stored in fresh disinfecting solution overnight. In the morning, lenses are rinsed again before being filled with preservative-free saline and inserted.
- Clean lenses with the recommended solution after every removal
- Store lenses in fresh disinfecting solution each night
- Fill lenses with preservative-free saline before each insertion
- Replace lens cases regularly as directed by your provider
- Wash and dry hands thoroughly before handling lenses
- Attend all scheduled follow-up appointments to monitor lens fit and eye health
Your Journey with Scleral Lenses
Your scleral lens journey begins with a comprehensive consultation at one of our Maryland locations in Greenbelt, Rockville, or Cumberland. During this initial visit, your provider will review your ocular history, perform diagnostic testing, and discuss whether scleral lenses are the right solution for your visual needs. This appointment sets the stage for a personalized treatment plan.
Washington Eye Institute maintains an extensive scleral trial lens inventory, allowing your specialist to begin the fitting process efficiently. Our advanced diagnostic equipment and experienced care team ensure that each step of your journey is guided by precision and attention to detail.
Most patients experience a short adaptation period as they become accustomed to scleral lens wear. During the first few days, the lenses may feel slightly different from what you are used to, and the insertion and removal process may take extra time. This is entirely normal. With practice, handling becomes second nature for most wearers.
Your care team is available to answer questions and provide support throughout the adaptation period. If you experience persistent discomfort, fogging, or difficulty with handling, contact your provider promptly so that adjustments can be made. Early communication helps resolve issues quickly and keeps your progress on track.
Scleral lenses are designed for long-term use, and many patients wear them successfully for years. Regular follow-up visits allow your provider to monitor your corneal health, assess lens fit, and update your prescription as needed. Over time, changes in your eye's shape or condition may require lens modifications.
Your ongoing relationship with your care team at Washington Eye Institute is an important part of maintaining excellent vision and comfort. We recommend annual comprehensive evaluations in addition to any visits prompted by changes in your vision or comfort. Together, we will ensure that your scleral lenses continue to meet your needs.
Many patients arrive at our practice feeling frustrated after years of unsuccessful attempts with other forms of vision correction. Scleral lenses often represent a turning point, providing the clarity and comfort that had been previously out of reach. As you gain experience with your lenses, you will likely notice improvements in your daily activities, work performance, and overall quality of life.
Your care team celebrates these milestones with you and remains committed to your long-term success. Whether you are managing keratoconus, recovering from corneal surgery, or seeking relief from severe dry eye, scleral lenses offer a path to better vision and greater comfort.
Questions and Answers
Many patients find scleral lenses to be among the most comfortable contact lenses they have worn. Because the lens rests on the less sensitive sclera and does not touch the cornea, irritation is minimal. The saline reservoir provides continuous hydration, which is especially beneficial for patients who have experienced dryness or discomfort with other lens types. Most wearers report comfortable wear for extended hours each day.
The fitting process typically involves several appointments spread over a few weeks. Your initial consultation includes diagnostic imaging and trial lens evaluation. A custom lens is then ordered and evaluated at a follow-up visit. Most patients achieve their final fit within two to four visits, though complex cases may require additional adjustments. Your care team will keep you informed at each stage.
Many patients who were told they could not wear contact lenses are excellent candidates for scleral designs. Traditional soft lenses may not work for patients with irregular corneas, severe dry eye, or post-surgical complications, but scleral lenses are specifically designed for these challenging situations. A thorough evaluation by your contact lens specialist will determine whether scleral lenses can work for you.
Air bubbles are a common concern for new scleral lens wearers. The key is to fill the lens completely with preservative-free saline, tilt your head forward so you are looking straight down, and bring the lens directly onto your eye in a smooth, steady motion. Maintaining a level lens bowl and avoiding tilting during insertion helps the saline remain in place. Your care team will coach you on technique until you can insert your lenses consistently without bubbles.
Scleral lenses are durable and, with proper care, can last for one to two years before replacement is needed. Over time, surface deposits, minor scratches, or changes in your prescription may require a new lens. Your provider will assess lens condition during follow-up visits and advise you when replacement is appropriate. Consistent daily cleaning and careful handling help maximize the lifespan of your lenses.
Scleral lenses are well suited for physical activity. Their large diameter and secure fit on the sclera make them resistant to dislodging during movement, unlike smaller contact lenses that may shift or fall out. Many athletes and active individuals prefer scleral lenses for the stable, clear vision they provide during sports, exercise, and outdoor activities. Protective eyewear is still recommended for contact sports as an added precaution.