Scleral Contact Lenses for Keratoconus & Irregular Corneas

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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. Scleral lenses are custom made and wearing them improves vision as well as (or better than) eyeglasses or traditional soft 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 are 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 are large in diameter and feature a reservoir, which the user fills with saline. They cover a portion of the sclera, which is the white of the eye. Instead of touching the cornea (like soft contacts), scleral lenses vault over the cornea.


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Scleral lenses also have a greater range of sizes and span the entire surface of the cornea, unlike gas permeable lenses that 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 approximately 14.5 mm to 24 mm. The average human 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 corneoscleral or mini-scleral lenses. They work well for people who need large gas permeable lenses. They are also worn by people who have undergone LASIK eye surgery and need correction for astigmatism

The size of the lens is determined by the degree of complexity of someone’s vision issue. 

Someone with a complex condition, pathologically dry eyes, or ocular surface disease requires large lenses because they need a larger tear reservoir.

Who Should Use Scleral Contact Lenses? 

Scleral contact lenses are ideal for many people who cannot wear regular contact lenses but want their best vision without wearing eyeglasses. Some people cannot wear traditional contacts due to pathologically dry eyes or other conditions that make wearing contacts uncomfortable. 

People with conditions such as Sjogren’s syndrome, Stevens-Johnson syndrome, or graft-versus-host disease (GVHD) that cause dry eyes often find scleral lenses more wearable than regular contact lenses. 

People with hard-to-fit eyes due to keratoconus do especially well with scleral lenses. People in the early stages of keratoconus might use gas permeable lenses. But if these don’t fit properly or they move around in the eyes, scleral lenses might offer an alternative. 

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. It’s never smart to 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? 

Scleral contact lenses cost significantly more than regular contacts because they are custom-fitted. Fitting them requires the creation of a computerized map that measures 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. 

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.

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.

Modern scleral lenses are comfortable and offer significant vision improvement. If you believe you are a good candidate for scleral lenses or you’re tired of wearing glasses and want a comfortable solution that improves your vision, speak to your optometrist or eye care professional about your contact lens options.

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Resources
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Office of the Commissioner. “Focusing on Contact Lens Safety.” FDA, 20 Nov. 2019.

Why Do People Wear Hard Contact Lenses?” Scienceline, 25 June 2007.

Update on Scleral Lenses.” American Academy of Ophthalmology, 31 Oct. 2018.

Protect Your Eyes.” Centers for Disease Control and Prevention, 27 July 2020.

Contact Lens Safety.” Veterans Health Administration. 

Contact Lens Safety Tips.” UC San Diego Health. 1 September 2020.

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