Do I Need to Stop Wearing Scleral Lenses?
October 22, 2024
If you have keratoconus and have an upcoming visit with an ophthalmologist (an eye surgeon), the scheduler may have instructed you to stop wearing your scleral contacts for three weeks or longer. Seriously?!? Do you really need to stop wearing your scleral lenses for that long before a surgical eye appointment? For contact lens evaluation and prescribing, you probably know that you go into the appointment wearing scleral lenses so that they can be evaluated on your eyes for potential modifications.
A handful of our keratoconus patients receive guidance to stop wearing scleral lenses before scheduling with an eye surgeon. Yet discontinuing wearing scleral lenses poses a significant hardship because most with keratoconus cannot function without these custom contact lenses. Fortunately, in most cases, it is not necessary to discontinue scleral lens wear, except when certain types of eye surgery are contemplated. Learn more, below. To be sure though, you should double check with the office that requested you to stop wearing scleral lenses. There may be unique circumstances that apply to you. But most of the time, the scheduling office is confusing scleral gas permeable lenses with corneal gas permeable lenses. Corneal gas permeable lenses can confound surgical planning.
Scleral Lenses Are Unfamiliar to Many Eyecare Professionals
Scleral contact lenses are custom rigid surface lenses, prescribed mostly to restore vision for specific eye diseases including keratoconus. Only a small percentage among the entire contact lens wearing population wear them. In fact, most eye doctors do not regularly prescribe scleral contact lenses. For that reason, their staff may not have familiarity with their nuances and intricacies.
Scleral lenses are rigid surface contact lenses. This is why ophthalmologists, or eye surgeons, and their staff confuse them with corneal rigid gas permeable (RGP) contact lenses. Corneal RGP lenses are smaller and an older treatment for keratoconus. RGP lenses unintentionally mold the cornea, the clear dome of the eye that focuses light into the eye, usually in an unpredictable manner. This molding does not occur with scleral contact lenses, because when they are properly prescribed, they rest on the outer sclera or white part of the eye, not the central cornea.
Corneal RGP Lenses Confound Assessment for Eye Surgery
The temporary warping or molding effect of corneal rigid gas permeable (RGP) can interfere with an eye surgeon’s ability to perform corneal cross-linking and cataract surgeries. This is why they may ask you to discontinue wearing scleral lenses, mistakenly believing that they are RGP lenses.
Corneal cross-linking is the surgery to halt or slow progressive keratoconus. RGP lens wear can confound the doctor’s ability to detect whether keratoconus is progressing. Disease progression is common before the third to fourth decade of life. With progressing keratoconus, the cornea becomes more distorted and thinner. Progression may be accompanied by decreasing vision with eyeglasses and increased scar tissue of the cornea. Most medical insurances that pay for corneal cross-linking to stop disease progression require documentation that there is disease progression but without contact lens-induced corneal molding.
Corneal molding from the corneal RGP lenses can also confound the calculations for intraocular lens implantation for cataract surgery. Just like anyone else, most with keratoconus can expect to benefit from cataract surgery during life. The best outcome with cataract surgery requires eliminating corneal molding to allow an accurate and stable intraocular lens power calculation.
Discontinue Corneal Gas Permeable Lenses and Hybrid Lens Wear for Surgical Assessment
Rigid contact lenses include scleral gas permeable, corneal gas permeable contact lenses, and hybrid contact lenses. Corneal gas permeable contacts and hybrid lenses can mold the cornea and interfere with surgical planning for cross-linking and cataract surgery. By comparison, appropriately prescribed scleral lenses do not cause this effect.
Some eye surgeon offices make a blanket recommendation that you should discontinue any rigid contact lens wear prior to assessment for corneal cross-linking or cataract surgery. Although this is a simple and conservative guidance, it burdens scleral lens wearers by unnecessarily making them struggle to see for weeks before their appointment. If this potentially applies to you, you should clarify with your eye surgeon’s office that you are wearing scleral lenses and not corneal gas permeable or hybrid lenses.
ReVision Optometry is a referral-based practice in San Diego providing contact lens services for patients with keratoconus. To schedule an appointment, request your appointment online, or call our office at 619.299.6064.