Scleral Lenses: Who Are They For and What Is the Fitting Like?

Scleral lenses are large, rigid contact lenses that arch over the cornea and rest on the white part of the eye, with a layer of fluid trapped underneath. They help people with irregular or very dry corneas see clearly and comfortably when glasses and regular contacts haven't worked. Common reasons include keratoconus, scarring, past eye surgery and severe dry eye.

Some of my favorite moments happen during a scleral fitting. A patient who has squinted through blur for years puts on a lens, gets quiet, and reads a line they didn't know they could read.

What exactly is a scleral lens?

Most contacts sit right on the cornea, the clear dome on the front of your eye. A scleral lens is bigger than the colored part of your eye and is shaped so it doesn't touch the cornea. It lands gently on the sclera, the white of the eye.

Before you put it in, you fill the bowl of the lens with sterile saline. That fluid stays between the lens and your cornea, and it does two jobs:

• It smooths out the surface. If your cornea is bumpy or cone-shaped, the fluid fills in the uneven spots, and the smooth front of the lens takes over the work of focusing light.
• It keeps the cornea bathed. For a very dry or damaged eye, it's like giving the cornea its own little pool to rest in all day.

Because the lens rests on the less sensitive white of the eye, many people find sclerals more comfortable than they expect.

Who are scleral lenses for?

Keratoconus

In keratoconus, the cornea thins and bulges forward into a cone. Vision gets blurry and distorted in a way glasses often can't fix. Sclerals are one of the most common ways to give these patients clear vision.

Irregular corneas after surgery or injury

A cornea can become uneven after a corneal transplant, past refractive surgery such as LASIK or RK, an injury, or scarring from an old infection. Sclerals can mask that irregular surface.

Severe dry eye and ocular surface disease

For people with very dry eyes, including dry eye linked to autoimmune conditions or graft-versus-host disease, the fluid reservoir can protect the cornea and calm symptoms. We usually look at this as one part of a bigger dry eye care plan, not the whole answer.

People who've "failed" with other contacts

Some people have tried soft, rigid and hybrid lenses and given up because they hurt, popped out, or never gave crisp vision. Sclerals are worth a look, and they can also suit some high prescriptions.

What is the fitting like?

I'll be honest: a scleral fitting is a process, not a quick visit. It's worth it.

Mapping your eye

We start with a full eye-health exam, then map the shape of your cornea and the front of your eye in detail, including where the lens will land.

Trial lenses

Next, we place a trial lens and check it under the microscope: how high it sits above the cornea, where it rests, and whether it pinches or lifts anywhere. We let it settle for a while, because lenses sink a little with wear.

Ordering and refining

Your lenses are made to order. Expect a few visits, and it's common to adjust the design once or twice to fine-tune comfort and vision.

Learning to put them in and take them out

This is the part people worry about most. You'll learn in the office with us beside you.

• Insertion: You fill the lens with sterile, preservative-free saline, set it on a small plunger or on your fingertips, look straight down, and bring the lens up to your eye. If an air bubble gets trapped, you take it out and try again.
• Removal: You use a small suction plunger on the edge of the lens, or a finger technique, to gently break the seal.
• Cleaning: You clean and disinfect the lenses with the solutions we recommend, every day. Never use tap water to rinse or fill your lenses, and never fill them with anything other than the saline we recommend.

Is there a learning curve?

Yes. The first week can feel clumsy, but most people get faster with practice until it's just part of the morning routine. A few things to know:

• Midday fogging. Some people notice vision getting a little cloudy after several hours. Removing, refilling and reinserting the lens usually clears it. If it keeps happening, tell us, because a fit adjustment can help.
• Bubbles. A small bubble under the lens can cause blur or discomfort. Remove and reinsert.
• Follow-up visits. Sclerals need regular checkups so we can watch the health of your cornea under the lens.

When should you see an eye doctor?

Make an appointment if your vision is blurry or distorted even with glasses, or if your contacts are uncomfortable.

If you wear scleral lenses, take them out and call us the same day if you have:

• Eye pain, or pain that doesn't go away after removing the lens
• A red eye with light sensitivity
• Sudden blurry vision that doesn't clear when you refill the lens
• A white or gray spot on the clear front of your eye
• Discharge from the eye

Call us right away or go to the emergency room for sudden vision loss, a curtain or shadow across your vision, new flashes and floaters, or any chemical splash in the eye.

How we do it at Bolt Eye Group

At Bolt Eye Group, we fit scleral and specialty contact lenses. Every fitting starts with a comprehensive eye exam and a full eye-health check. Every patient also gets retinal photos and corneal topography for a $39 imaging fee. Topography maps the shape of your cornea, which helps us design your lens. Learn more about our advanced imaging.

We take the fitting step by step, teach you insertion and removal in the office, and see you back for the follow-up visits it takes to fine-tune the fit.

We accept VSP, EyeMed, Davis Vision, Spectera, Medicare and major medical plans, including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna and Humana. We're happy to check what your plan covers. HSA/FSA and CareCredit are welcome.

Frequently asked questions

Do scleral lenses hurt?

Most people find them comfortable once the fit is right, because the lens rests on the less sensitive white of the eye instead of the cornea. The first few days feel new. Pain is not normal, so if it hurts, take the lens out and call us.

Can scleral lenses cure keratoconus?

No. Scleral lenses improve vision, but they don't change the shape of the cornea or stop it from changing. Your eye doctor will still monitor your keratoconus and talk with you about other treatments when they're needed.

How long does a scleral lens fitting take?

Usually several visits over a few weeks. That includes mapping the eye, trial lenses, ordering, and fine-tuning. Taking that time is what gets you a lens that's comfortable all day.

Can I sleep in scleral lenses?

They are generally not designed for overnight wear. Take them out before sleep unless your eye doctor gives you different instructions for your specific situation.

Book an exam at your nearest Bolt Eye Group office

If glasses and regular contacts haven't given you the vision you want, let's talk about scleral lenses. Book an exam at your nearest Bolt Eye Group office in Canton, East Cobb/Marietta, Lawrenceville, Riverdale or Johnson City, TN. See all locations and directions.