Scleral lenses are large-diameter, gas-permeable contact lenses that rest on the sclera, the white part of the eye, rather than the cornea. By vaulting over the cornea, they create a fluid-filled reservoir between the lens and the eye’s surface. This design provides two major benefits: it smooths out the irregular corneal shape common in keratoconus and keeps the eye hydrated throughout the day.
For people with keratoconus, this results in sharper, more stable vision and increased comfort, especially when other forms of correction like glasses or traditional contact lenses fall short. Scleral lenses are often a reliable option when other forms of vision correction fall short.
Understanding Keratoconus
Keratoconus is a condition where the cornea gradually thins and bulges outward, taking on a cone-like shape. This irregular shape causes light to scatter as it enters the eye, leading to distorted or blurred vision.
Many people with keratoconus experience symptoms like:
- Increased light sensitivity
- Difficulty seeing at night, ghosting, or double vision
- And frequent changes in prescription
As the condition progresses, glasses and standard contact lenses may no longer provide clear or comfortable vision.
Why Scleral Lenses Work Well for Keratoconus
Keratoconus typically progresses through four stages, from mild to end-stage, each with increasingly irregular corneal shape and vision challenges. Here’s where scleral lenses fit in:
Stage 1 (Mild)
- Typical treatment: Glasses or soft contact lenses are usually sufficient.
- Why not scleral lenses? The cornea is relatively regular, so these simpler options generally work well.
Stage 2 (Moderate)
- Typical treatment: Rigid gas permeable (RGP) lenses are often used.
- Where scleral lenses come in: When irregular astigmatism increases or RGPs become intolerable, scleral lenses begin to shine. Their vaulting structure offers a smooth optical surface over the irregular cornea, boosting vision clarity.
Stage 3 (Severe)
- Typical treatment: Custom RGPs often struggle, leaving patients with blurry vision or discomfort.
- Why scleral lenses excel: At this point, scleral lenses are often a great non-surgical option. Studies show that they significantly improve vision, reduce higher-order aberrations, and enhance comfort..
Stage 4 (End-Stage)
- Obstacles: Severe thinning, scarring, or acute swelling limit most corrective lenses.
- What helps: In select cases, scleral lenses may still provide functional vision and comfort, but many patients will ultimately need surgical interventions (e.g., corneal transplant).
Other Contact Lens Options for Keratoconus
In addition to scleral lenses, there are several other types of contact lenses that are used to manage keratoconus.
Soft Contact Lenses
Soft lenses may be used in the early stages of keratoconus, but they generally can’t correct for the significant distortion caused by later stages of the condition.
Hybrid Lenses
These lenses have a rigid center and soft skirt, combining the visual clarity of an RGP with the comfort of a soft lens. They may help in moderate cases of keratoconus.
Added Benefits for Dry Eye
Scleral lenses are also beneficial for people who experience dry eye along with keratoconus. The fluid reservoir held by the lens keeps the corneal surface bathed in moisture throughout the day.
This feature helps reduce symptoms like burning, stinging, or a gritty feeling. People who have not found relief from eye drops or standard contact lenses may discover improved comfort with scleral lens wear.
The Fitting Process
Fitting scleral lenses is a personalized and detailed process. It starts with imaging tools, such as corneal topography, to measure the shape and surface of the eye.
From there, lenses are custom-designed to match a person’s measurements. It often takes a few visits to fine-tune the fit, but once complete, patients can enjoy the comfort and clarity these lenses provide.
Steps often include:
- Digital scans of the eye’s surface
- Lens selection and trial fitting
- Adjustments for clearance, comfort, and alignment
- Training on insertion, removal, and cleaning
A Non-Surgical Option
While some people with progressed keratoconus may eventually consider surgical treatments, like corneal cross-linking or transplants, scleral lenses are often used to delay the need for surgery.
In many cases, scleral lenses continue to be used even after surgical intervention to support healing and refine vision correction. They’re a valuable part of a long-term management plan for keratoconus.
Specialized Care Makes a Difference
Successfully fitting and managing scleral lenses requires both technology and experience. Personalized care, paired with a thorough fitting process, helps patients get the most from these lenses.
At Tree City Eyecare, scleral lenses are part of our treatment approach for keratoconus. With a welcoming and professional environment, our team supports patients through every stage of fitting and follow-up, helping them see clearly and comfortably. If you’ve been diagnosed with keratoconus or are struggling with contact lens comfort, schedule a consultation to find out if scleral lenses are right for you.