Scleral contact lenses are a great solution for many people who find that eyeglasses or regular contact lenses don’t work well for them. In recent years, they’ve gained popularity due to their superior visual performance, as well as their ability to fit challenging misshapen corneas and high prescriptions. 

If you’re interested in learning what scleral lenses are and whether you should ask your eye doctor about them, keep reading—we’ll explore everything you need to know about this eye care solution and whether it’s right for you. 

What are Scleral Contact Lenses?

Scleral lenses are a type of contact lens that rests upon the sclera—the white of the eye. They are wider than regular contact lenses, which rest on the eye’s corneal surface. 

Scleral lenses bridge the cornea and are separated from the eye by a tear-filled chamber, helping to provide hydration. They are preferred by many patients who find regular lenses uncomfortable due to the lens sitting poorly on the corneal surface and who have corneal issues or degeneration. 

Dr. Samuel Teske, an optometrist here at True Eye Experts, describes his experience with scleral lenses and why he recommends them for his patients:   

“I first heard about Scleral contact lenses in 1998 when I read an article from an optometrist, Dr. Stephen Johnson. He utilized them on a patient of his that achieved 20/10 vision. This patient was home run champion and baseball star, Mark McGwire.  Mark reported, once he started using Sclerals the baseball looked more like a beach ball as it approached the plate.   

What was impressive was that Mark’s vision was especially poor without vision correction, in the neighborhood of 20/500 vision,  which is considered legal blindness.  Additionally, Mark was nearsighted and had a large amount of astigmatism.” 

Mark McGwire batting.

McGwire’s success story was just the start—since then,  many more patients have been fitted with scleral lenses to improve their performance in sporting activities.  

Scleral lenses can even be customized for a particular sport. For example, a tennis player may have scleral lenses with a slight green tint so that the ball appears darker, making it easier to track. But you don’t have to be an athlete to enjoy the benefits of scleral lenses—tinted lenses can also be used to reduce glare for patients with light-sensitivity issues due to cataracts, macular degeneration, or another issue. 

How Do They Work?

How do these lenses provide such great vision? There are several reasons to consider. One reason is that our corneas are not perfectly round surfaces, and this can alter our vision. Keratoconus—a condition where the cornea is highly misshapen—can make it extremely difficult to fit regular soft contact lenses or glasses.  

Additionally, nearly 85% of the population has astigmatism—an imperfect curve of the cornea. Severe astigmatism can sometimes be a sign of something more serious. These conditions can affect your vision, but scleral lenses are able to help by correcting the shape of the eye. 

Scleral lenses were developed in a way that regulates the shape of the eye, providing a perfectly round, spherical surface for precise vision.  The cornea—the clear tissue covering the front portion of the eye—is not a perfectly round surface.  In addition to causing vision problems, conditions that affect the shape of the cornea can also make it much more difficult to be fitted for traditional soft lenses and eyeglasses.  Scleral lenses, which are more accurately fitted to the eye, may be a better choice for these patients to provide the best vision possible.

Who Are Scleral Lenses Designed For? 

A scleral contact lens might benefit patients suffering from: 

  • Keratoconus
  • Pellucid Marginal Degeneration
  • High Astigmatism
  • Injuries to the eye from burns or chemicals
  • Dry Eye Syndrome
  • Corneal degeneration
  • Corneal dystrophy
  • LASIK-related complications like corneal ectasia

The lens avoids direct contact with the cornea, meaning that patients who have suffered injuries to their cornea or have irregularities in its surface don’t feel the discomfort caused by regular contacts.  

If you experience any of these conditions, or if you find contacts abrasive or irritating, contact your optometrist to discuss the possibility of using scleral lenses. 

Am I a Candidate for Scleral Lenses? 

You may be a good candidate if you suffer from any of the conditions listed above.  Some patients don’t know they have these conditions—they may just accept their poor vision. It is also possible that a patient’s current eye care providers may not be using the right equipment and technology to detect them. 

At our True Eye clinics, we have found many patients with these conditions (as young as their thirties and forties) who didn’t know that their poor vision could be much clearer.  We’ve had professional athletes and even surgeons that were misdiagnosed and helped greatly by scleral contact lenses.  

Image of a corneal topographer.

How Are They Fitted?

Precise measurements are essential to get great-fitting scleral lenses.  Many technologically advanced practices will use 3D scans of the cornea called corneal topography, as well as high definition ultrasound scans called Optical Coherence Tomography, or OCT imaging.

A corneal topographer is essential to detect a misshapen cornea.  A topographer measures the 3D shape of the cornea and provides the doctor with very accurate measurements of the cornea shape.

By using this technology to accurately map the surface area of the eyeball, your eye doctor will then be able to create a lens that is perfect for your eyes. This allows for the lens to accommodate unusual eye shapes, giving you the comfort and effectiveness that conventional lenses and eyeglasses may not provide. 

Doctor gesturing to an OCT imaging result.

Are They Comfortable?

Scleral lenses are very comfortable.  Why are they so comfortable?  Well, they never touch the most sensitive part of the eye, the cornea.  The cornea has the highest density of nerves in the entire body. Anything important in the body tends to have more pain receptors.  As we know, when you get an eyelash in your eye the world stops until you get it out.  Most people think they get it out, but really it just moved to the white part of the eye, the sclera.  The scleral has fewer pain nerves which helps make the lenses much more comfortable. 

While the purpose of these lenses is to avoid corneal discomfort, the feeling of the lens touching the sclera takes some getting used to. Most patients find they become accustomed to this sensation after a few weeks. Basically, it’s “different” rather than “uncomfortable,” which is the problem many patients have with regular contacts.

The extra hydration provided by scleral lenses also helps to improve eye comfort in the long term. 

How Do You Insert and Remove Them?

Scleral lenses are inserted with a similar technique that is used with soft and hard lenses.  They are larger in diameter than a Rigid Gas Permeable (RGP) lens and sometimes larger than a typical soft contact lens.  This can make it more difficult to insert, especially for patients that have never worn contact lenses.  

At True Eye Experts, we have many new contact lens wearers in scleral lenses, and insertion is generally never a problem after some practice. Removal is done by using a special plunger that works very well.

A scleral contact on a plunger.

Much like soft contact lenses or RGP lenses, scleral contact lenses should not be worn overnight.  The lack of oxygen to the cornea can permanently damage the eyes.

Conclusion: Scleral Contact Lenses

It’s important to find an optometrist that specializes in scleral contact lenses to ensure your best possible fit. If you think you could benefit from scleral contact lenses, talk to your optometrist. Schedule an eye care appointment at a True Eye Experts location in Florida today for a comprehensive eye exam to learn which solution is best for you.