Who Is a Candidate for Scleral Lenses?
Scleral lenses are commonly used in conditions that cause an irregularly shaped cornea, such as keratoconus, or with corneal transplants and corneal scarring. But they’re also used to help people with severe dry eye disease and ocular surface disorders, Kampani says.
- Corneal diseases and conditions that cause cornea-shape irregularities
- Other forms of irregularities like astigmatism
- Refractive surgery patients, such as those who have undergone Lasik eye surgery
- Scarring or corneal damage from injuries
- Disorders that affect the eyelid or area surrounding the eye
- Conditions that require applying medication to your eye surface and keeping it there
Galor says scleral lenses can be especially beneficial for patients whose eyes struggle to produce or maintain adequate tears. With Stevens-Johnson syndrome, for example, where long-term recovery of the ocular surface may be limited, scleral lenses provide a continuous lubricating environment over an extremely dry and damaged eye surface, she says.
They’re also useful in cases where medication needs to be administered, she says. “The fluid reservoir beneath the lens helps protect and hydrate the cornea throughout the day, and medications can sometimes be added to the reservoir along with preservative-free saline, such as autologous serum tears in selected patients,” she says.
Scleral lenses are not limited to people who already wear contact lenses. “I have many patients who use these lenses for dry eyes who have never used contacts before,” Kanevsky says.
That said, scleral lenses are not the right fit for everyone. Because they require daily insertion, removal, and cleaning, patients need hand-eye coordination and manual dexterity. “Patients with hand tremors, severe arthritis, or young children, for example, will have a much more difficult time,” Kanevsky says.
For many patients, putting on the lenses can initially feel intimidating. Kanevsky says she remembers fitting her first scleral lens more than a decade ago on a patient who had two consecutive corneal transplants.
“The biggest challenge to this day remains overcoming the fear of placing an intimidatingly large object precariously balanced on one’s fingertips, filled with fluid, while hovering facedown over a table or sink all the while praying that it doesn’t go down the drain and it goes in without an air bubble,” Kanevsky says. “Once the patient gets over that steep learning curve, the lenses themselves are truly life changing.”
Patients must also have stable corneal and ocular tissues to tolerate the lenses, Kampani says. If you’ve had a corneal transplant that is stressed or swollen, a scleral lens may not be a good option until the area calms.
