What are Scleral Contact Lenses?
Scleral contact lenses are large-diameter gas-permeable contact lenses. They cover the entire corneal surface and the white (sclera) of the eye.
This provides a perfectly smooth optical surface, correcting 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 wear lenses comfortably.
People unable to wear regular contact lenses due to irregular corneas or other problems might be able to wear scleral lenses. They're custom made and improve vision as well as (or better than) eyeglasses or traditional contact lenses.
Scleral Contacts vs. Normal Gas Permeable (GP) Contacts
Both scleral lenses and gas-permeable lenses are made from a rigid material molded into a dome shape. Aside from that, these two types of lenses are 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 the majority of the cornea.
Scleral lenses, on the other hand, have two additional unique features.
- They're large in diameter and feature a reservoir, which the user fills 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 surface of the cornea. This is unlike gas permeable lenses, which are smaller and only cover about three-quarters of the corneal surface.
Many people turn to scleral lenses when gas-permeable lenses aren’t comfortable for them.
Types of Scleral Contact Lenses
Scleral lenses range in size from around 14.5 mm to 24 mm. The average cornea is just under 12 mm in size, so even the smallest scleral lenses cover the entire surface of the cornea.
Scleral lenses that are only 13 to 15 mm in size are called mini-scleral lenses. They work well for people who need large gas-permeable lenses.
They're also worn by people who have undergone LASIK eye surgery for astigmatism.
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?
A variety of conditions may cause people to find contacts to be uncomfortable.
These can include:
- Pathologically dry eyes (also known as dry eye disease)
- Sjogren's syndrome
- Stevens-Johnson syndrome
- Graft-versus-host disease
Additionally, scleral lenses work well for people who have undergone corneal transplants.
How Long Can You Wear Scleral Contacts?
Scleral lenses usually need replacement every three years or so as long as they are maintained properly.
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.
Wearing lenses when sleeping prevents oxygen from getting to the cornea, which increases the risk of ulcers or infection.
It’s also important to 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.
- Affordability. 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:
- Getting the right lens takes time and requires working with a doctor with special training.
- Scleral lenses cost a lot more than traditional contacts – up to four or five times as much.
- 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.
- The adjustment period takes time. If you’ve worn soft contacts, getting used to scleral lenses might require some time because they feel so different.
- Lenses tend to slip off the center of the eye. This can happen several times a day. 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 gas permeable 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 per lens to as much as $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 curvature of the cornea.
Several trial lenses of different curvatures and sizes are tried during the fitting process.
There might be additional adjustments needed, depending on the complexity of someone’s vision problems.
Why Are Black Sclera Contacts So Expensive?
Black sclera contacts are often used in Hollywood movies as an inexpensive way to achieve a scary look.
They used to be expensive for a few reasons:
- It takes time to produce material that's black but also allows the wearer to see
- The material is medical-grade
- They're custom made
In recent years, the production costs of black sclera contacts have decreased significantly, making them less expensive than they used to be.
Does Insurance Cover Scleral Contacts?
Insurance usually doesn’t cover the entire cost of scleral lenses. 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 offer financing options for patients who would benefit from scleral contacts.
This allows people who wear contact lenses to choose between scleral lens and traditional contact lenses without as much concern for cost.
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