What are Scleral Contact Lenses?
Scleral contact lenses are large-diameter gas-permeable (GP) contact lenses. They cover the entire corneal surface and the white (sclera) of the eye.
This provides a perfectly smooth optical surface to correct vision problems caused by corneal irregularities.
In scleral lenses, the space between the surface of the lens and the cornea acts as a fluid reservoir. This allows people with severe dry eyes to comfortably wear lenses.
Scleral lenses are suitable for people unable to wear regular contact lenses due to irregular corneas or other problems. They're custom-made and improve vision. They can sometimes work better than eyeglasses or traditional contact lenses.
Scleral Contacts vs. Normal Gas Permeable (GP) Contacts
Scleral and GP lenses are molded from a rigid material into a dome shape. These two types of lenses are notably different.
Gas-permeable contact lenses are rigid and made of durable plastic that allows oxygen to pass through the lens. They're smaller in diameter than soft contacts or scleral lenses, covering most of the cornea.
Scleral lenses have two additional unique features:
- They're large in diameter and feature a reservoir, which you fill with saline.
- Instead of touching the cornea (like soft contacts), scleral lenses vault over the cornea, covering the sclera.
Scleral lenses also have a greater range of sizes and span the entire cornea surface. This is unlike GP lenses, which are smaller and only cover about three-quarters of the corneal surface.
Many people use scleral lenses when GP lenses aren’t comfortable.
Types of Scleral Contact Lenses
The types of scleral contact lenses are categorized by size:
- Corneo-scleral and semi–scleral lenses
- Mini scleral lenses
- Full scleral lenses
The size of the lens is determined by the degree of complexity of the issues.
People who need larger lenses include those with pathologically dry eyes or ocular surface disease. This is because they need a larger tear reservoir.
Who Should Use Scleral Contact Lenses?
You may be an ideal candidate for scleral contact lenses if you have one of the following conditions:
- Pathologically dry eyes (also known as dry eye disease)
- Sjogren's syndrome
- Stevens-Johnson syndrome
- Graft-versus-host disease
Scleral lenses also work well for people who have undergone corneal transplants.
How Long Can You Wear Scleral Contacts?
Scleral lenses usually need replacement every 3 years or so as long as you properly maintain them.
Remember the following when wearing scleral contacts:
- Like all types of contact lenses, eye health experts encourage wearers to remove them after several hours of use .
- Never leave your contacts in while you sleep because doing so increases the risk of ulcers or infection.
- Clean your lenses and keep them moist with contact solution when not in use.
Pros and Cons of Scleral Contact Lenses
Scleral lenses offer many benefits, including:
- Breathability. These lenses allow a lot of air to reach the cornea. This makes them more comfortable to wear for longer periods.
- Cost-effectiveness. Scleral lenses are more expensive initially, but you don’t need to replace them as frequently.
- Less risk of bacterial infections. Scleral lenses don’t hold water, so there’s less of a risk of bacteria and harmful buildup on the lens.
- Custom-fitted. Lenses are designed to fit a person’s specific vision prescription and cornea, so they offer maximum vision correction.
- Wider range of options. Because they are custom-designed, people who cannot wear regular lenses can wear scleral lenses. Additionally, people with corneal tissue damage can wear scleral lenses because they don’t touch the cornea.
Despite the benefits of scleral lenses, they aren’t right for everyone. The drawbacks of scleral lenses include:
- Time consuming. Getting the right lens takes time and requires working with a doctor with special training.
- Expensive. Scleral lenses cost more than traditional contacts – up to four or five times as much.
- Maintenance. Lenses require maintenance, which can make wearing them inconvenient. There’s a risk of fogging, getting debris in the reservoir, and scratching the surface. Some people need to remove them midday to clean them.
- Adjustment period. If you’ve worn soft contacts, getting used to scleral lenses might require some time because they feel different.
- Lenses tend to slip off the center of the eye. This can happen several times daily. They usually move back into place within a few seconds. But this still tends to be bothersome.
- Debris can slip between the eye and the lens. This happens less with scleral lenses than it does with GP lenses.
How Much Do Scleral Contacts Cost?
The average cost of scleral contacts is about three to four times more than regular contact lenses. You can expect to pay anywhere from $500 to $4,000 per lens.
Scleral contact lenses cost significantly more than regular contacts because they are custom-fitted. Fitting them involves using a computerized map to measure the cornea's curvature.
Several trial lenses of different curvatures and sizes are tried during the fitting process. Additional adjustments may also be needed, depending on the complexity of a person’s vision problems.
Does Insurance Cover Scleral Contacts?
Insurance usually doesn’t cover the entire cost of scleral lenses. However, some vision insurance plans reduce the cost of the lenses and/or the cost of being fitted for scleral lenses.
Different insurance providers offer varying degrees of coverage, so it’s important to check with your provider about your situation. Some eye care professionals may also offer financing options for scleral contacts.
Scleral lenses are a type of lens that offers more protection for your ocular surface. They have different pros and cons, and you must weigh them before making a decision. Consult your eye doctor to determine whether scleral lenses suit your needs.
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