Scleral Lenses – An Old Dog With New Tricks

scleral lensesScleral lenses have been around for over 100 years. Until the new gas permeable lens materials were developed patients could only wear scleral lenses for a few hours a day. With the highly oxygen permeable lens materials now in use, patients can comfortably wear these lenses all day. Scleral contacts are most commonly used to treat eyes with irregular corneas such as keratoconus and post-surgical eyes (usually following corneal transplant surgery or related to complications from refractive surgery). Another common use for scleral contact lenses is in the special effects industry where they are used to protect the cornea and/or to give the eye an exotic appearance.

What Is A Scleral Lens?

Scleral contacts are large contact lenses that rest on the sclera (white part of the eye) with the remainder of the lens vaulting over the cornea. Tears are trapped between the lens and the cornea allowing scleral contacts to treat irregular corneas. Scleral contact lenses are also used to treat dry eye syndrome by preventing the cornea from drying out. The average soft contact lens has a diameter of about 14 mm whereas scleral contacts typically have a diameter exceeding 14.5 mm. The larger diameter is one of the biggest reasons why scleral contacts are so comfortable. 

How Are Scleral Lenses used?

At Total Eye Care, Dr. Driscoll has used scleral contact lenses to treat many conditions such as irregular astigmatism, keratoconus, high myopia, dry eye syndrome, and complications related to LASIK and PRK. Because of their size, sclerals are quite comfortable. Patients often report the comfort being similar to that of a soft contact lens. Most patients with irregular corneas will see better with a scleral lens than with glasses. 

Below is a good video that shows how scleral contacts are cared for and how to insert and remove them.

9 responses to “Scleral Lenses – An Old Dog With New Tricks

  1. Hello Drs. Driscoll,

    Thanks for posting about sclerals. I desperately need these, as I am post-CXL (bilateral and done in 1 day) and have severe dryness now that will not respond to anything. My CXL was done in fall of ’12 in L.A. I have a rare, late-onset/rapidly-advancing form of keratoconus due to Ehlers-Danlos, Type II. Also have stubborn meibomitis and had 5 IPLs. Restasis for 3 mos and still waiting! The KC Dx led me to the EDS Dx (only took 12 yrs and lots of medical research on my part!). Does anyone mention this to patients?

    Why won’t insurance cover sclerals as “medically necessary” in the US? I’m so frustrated as I have good medical and the best vision insurance available. I hear Boston Sclerals are around $7k here in the US. I’m on disability from the EDS and already spent about that on CXL! I talk to Brits and Aussies on WP who can afford scleral lenses and CXL is covered, of course. Not fair! I’m contact lens intolerant and can’t see, despite getting 6 lines of VA back in my “bad” eye. Sclerals would be a win-win for me (vision/dryness). Are the US optometry associations doing anything in attempts to get these covered? I read these are considered “prosthetic devices.” Aren’t prosthetic limbs covered? Jeez!

    Thank you for any thoughts…

    • Scleral lenses have become a big part of our treatment of patients requiring a contact lens to treat a medical condition. CXL (collagen cross linking) will often stabilize the cornea, making it stronger and flatter while improving vision. Like you, I do find that patients may require some form of contact lens after CXL treatment to maximize their visual acuity.

      Major medical insurance or vision plans will sometimes help with the cost of these medically necessary lenses. You may need to call your medical insurance company or vision plan personally and see what coverage is available. Another possible resource is to check with your eye doctor. Doctors that fit these lenses on a regular basis are used to getting the approval of the medical insurance or vision plan. I hope that helps.

  2. Thank you, Dr. Driscoll. I have tried and my local corneal specialist feels scleral lenses will be the best option for me, but I get nowhere with either insurance despite numerous calls (except for covering hybrids, which is why I upped my coverage for ’13). They often don’t know what
    “medically necessary” means! The KC came on so fast that I have little familiarity with contacts in general. However, I now have the names of 2 lens fitters/ODs here who deal with scleral lenses and will see if they can pull some strings like you mentioned. Glad to know there may be a way to get through the insurance companies!

    Thanks you for your response and giving me a ray of hope…

    • BTW, if they cover hyprids then they cover sclerals. We have not found that they exclude a type of lens. If they cover medically necessary lenses then they don’t really care which type of lens is used. So that sounds like you are heading in the right direction.

      • Much appreciated and that gives me more hope. I think the problem is that the sub par insurance reps and office staff need some add’l training. I haven’t had the best medical/vision care in general, as healthcare in the SW is abysmal at best (I’m not a native). I will follow up with this OD whose name I just got who specialized in difficult cases and hope for the best! We’ll see what he says, but I believe I need to wait still due to continuing VA fluctuations post-CXL.

        Again, if I had been diagnosed in a timely manner, I wouldn’t have lost so much vision in a mere 9 mos and then you wouldn’t be stuck deciphering my typos! It makes me crazy, as we have good doctors (like you) back home.

        Thanks so much again for your help! Take care…

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  4. That’s a very informative write up on scleral lenses. Scleral lenses are of a great help to patients of Keratoconus.

  5. Great post. I hope you can write more good stuff like this article.