7 Benefits of Scleral Contact Lenses

by Brian Chou, OD, FAAO, FSLS

• November 8, 2020

Your doctor has recommended scleral contact lenses.  What are their benefits and are they right for you?

What are scleral contact lenses?

Scleral contact lenses are a relatively new but growing category of specialty contact lenses.  For many with challenging eye conditions they offer the hope of giving your life back.  They are made of a rigid and highly oxygen permeable material.  Slightly larger than a soft disposable contact lens, they are custom prescribed for your eye. These lenses afford numerous benefits for selected patients:

1. Unparalleled visual quality

For many, a rigid contact lens provides maximal vision.  Particularly those with high astigmatism and eye diseases like keratoconus, where the front eye surface is not smooth, rigid contact lenses are the gold standard for restoring vision.  Whereas certain soft contact lenses fluctuate vision when they rotate on the eye, scleral contact lenses can provide stable vision despite rotating with blink.

2. Comfort

Scleral contact lenses, when appropriately prescribed, feel like soft disposable contact lenses.  While this may seem counter-intuitive, the reason for this is because scleral lenses contact the white part of the eye which is relatively insensitive.  By comparison, the traditional smaller rigid contact lenses and hybrid contact lenses touch the sensitive cornea or front clear dome of the eye, causing lens awareness and discomfort.  Additionally, scleral lenses trap non-preserved saline fluid against the eye keeping the sensitive corneal surface hydrated and comfortable.  This is the reason why scleral contact lenses are also prescribed to treat medical dry eye, such as in Sjögren’s Syndrome where the body’s immune system attacks and damages the eyes’ tear-producing glands.

3. Protection

Once the scleral lenses are seated on the eye surface, they are stable and do not eject or dislodge, unlike traditional small corneal rigid contact lenses.  Since they seal the sensitive cornea from the atmospheric elements, they prevent dust from getting underneath as well as other irritants.  Scleral contact lenses are an excellent treatment for patients that work in dusty environments, or around chemical irritants.  For example, our patients that enjoy cooking and chop onions, and our patients in law enforcement that have exposure to pepper spray, note that scleral lenses provide increased eye comfort despite working with exposure to these eye irritants.  Finally, patients with eyelashes that are turned inward (trichiasis) can experience tremendous relief with scleral lens wear so that the lashes do not irritate or scar the corneal surface.  In these cases, scleral lenses serve as a shield, preventing the mechanical impact of the lashes against the eye.

4. No visual drift upon lens removal

Whereas the smaller corneal RGP (rigid gas permeable) and hybrid SynergEyes contact lenses can unintentionally mold the eye surface due to contacting the corneal surface, scleral lenses do not because scleral lenses vault the entire corneal surface.  The benefit to the wearer is that the vision and eyeglass prescription does not drift upon removal of scleral contact lenses.  However, patients wearing corneal RGP and hybrid contact lenses often note vision changing upon removal of these contact lenses.

5. Stability on the eye

Because scleral lenses are larger than corneal RGP lenses, they contact a greater surface area on the white part of the eye and provide assurance against dislodgement or ejection while gazing in different directions.  This means scleral lens wearers enjoying surfing or physical contact sports like football, basketball, and soccer, have the full confidence of knowing that their lenses will not pop out of the eye at the wrong time.

6. Durability

Scleral contact lenses are durable and reusable.  While you should be prepared to replace these lenses annually, they can last longer depending on lens care and factors unique to your eye, like their tendency to product protein, lipid, and mineral deposits on the contact lens surface.  Scleral lenses bring enduring value for most carefully selected patients.

7. Covered by necessity

For patients with eye disease (e.g. keratoconus, corneal scars, corneal deformity, etc.), specific third party payors including Vision Service Plan (VSP) and EyeMed may provide significant coverage for non-elective contact lens wear if the examination indicate specific measures of severity are met.  Often, it is not possible to know whether these criteria for medical necessity are met until a baseline evaluation is performed since the qualification can be complex and nuanced, and an experienced practice like ReVision Optometry can navigate this administrative maze for your benefit.  Even for our patients without necessary contact lens coverage for scleral contact lenses, professional and material fees are health savings account (HSA) and flexible spending account (FSA) eligible.

Despite benefits scleral lenses are not right for everyone

While scleral lenses are a godsend for many, they are not right for everyone.  For example, certain patients at risk for corneal edema and eye pressure problems are not suitable candidates.  Patients with narrow eye openings, a strong phobia to touching their eye, inability to hold their eye open, and poor manual dexterity (strong hand tremor) may not succeed with scleral lenses or any other type of contact lens.  Also, patients that do not have the time or willingness to undergo the prescribing process, which may extend over multiple visits over the course of several weeks, may not be the best candidates.  For a comprehensive assessment including an assessment on any anticipated out-of-pocket costs, you should schedule an evaluation for scleral contact lenses.

To find out if you are a good candidate for scleral contact lenses and what you might expect, request your appointment at ReVision Optometry today.