Scleral Contact Lenses

Clinical Applications, Fitting Considerations, and Patient Selection

At Knight Vision Northwest, scleral contact lenses are an advanced medical device used for ocular surface protection and visual rehabilitation. These specialty lenses are often prescribed for patients with complex corneal conditions or severe ocular surface disease who are unable to achieve clear, comfortable vision with glasses or conventional contact lenses.

Scleral lenses are large-diameter rigid gas-permeable (RGP) lenses designed to vault the cornea and rest on the sclera. By creating a fluid reservoir between the lens and the corneal surface, scleral lenses provide both optical correction and continuous corneal hydration.

What Are Scleral Contact Lenses?

Scleral contact lenses typically range in diameter from 14.5 to 24.0 mm and are designed to completely vault the cornea and limbus. Because they rest on the sclera rather than the cornea, scleral lenses minimize mechanical interaction with sensitive or irregular corneal tissue.

Key Design Features

• Complete corneal and limbal vault

• Fluid reservoir between the lens and corneal surface

• High-Dk materials to support corneal physiology

• Fully customizable designs for complex ocular anatomy

This design makes scleral lenses uniquely effective for patients with corneal irregularities or compromised ocular surfaces.

How Scleral Contact Lenses Work

Scleral lenses create a smooth, regular optical surface that neutralizes corneal irregularities while maintaining a stable tear reservoir over the cornea throughout the day.

Mechanism of Action

• Minimizes mechanical interaction with the cornea

• Neutralizes irregular astigmatism

• Protects compromised ocular surfaces

• Enhances visual acuity and long-term comfort

At Knight Vision Northwest, scleral lenses are often better tolerated than traditional corneal GP lenses, particularly in complex or medically fragile eyes.

Indications for Scleral Contact Lenses

Visual Rehabilitation

Scleral lenses are commonly indicated for patients with irregular corneas, including:

• Keratoconus and other ectatic disorders (H18.60–H18.63)

• Post-surgical corneal irregularities such as LASIK, PKP, or RK (H18.7, Z98.89)

• Irregular astigmatism

• Corneal scarring or degeneration

Ocular Surface Disease

The continuous hydration provided by scleral lenses makes them an effective treatment option for severe ocular surface conditions, including:

• Severe dry eye disease (H04.121–H04.123)

• Sjögren’s syndrome (H16.23)

• Graft-versus-host disease

• Neurotrophic keratopathy (H16.143)

• Exposure keratopathy

Contraindications and Clinical Cautions

Careful patient selection is essential for successful scleral lens wear. Potential contraindications and cautions include:

• Limited manual dexterity without caregiver support

• Active ocular infection or inflammation

• Noncompliance with lens care and hygiene

• Inadequate tear exchange without appropriate lens design modification

A comprehensive evaluation at Knight Vision Northwest helps determine whether scleral lenses are appropriate for each individual patient.

Clinical Benefits of Scleral Lenses

Patients who are good candidates for scleral contact lenses often experience:

• Stable and reproducible visual acuity

• Improved comfort compared to corneal GP lenses

• Reduced photophobia and ocular discomfort

• Continuous corneal hydration

• Potential reduction in corneal staining and epithelial breakdown

Scleral Lens Fitting Considerations

Scleral lens fitting is a highly customized clinical process requiring experience and precision.

Key Fitting Parameters

• Initial central corneal clearance typically 200–400 microns

• Evaluation of central and limbal vault

• Assessment of scleral landing zone alignment

• Monitoring for edge lift or conjunctival compression

Customization Options

• Toric or quadrant-specific haptics

• Adjustable sagittal depth

• Fenestrations when clinically indicated

Patient Management and Follow-Up

Typical Follow-Up Schedule

• Diagnostic fitting visit

• Dispensing appointment

• 1–2 week follow-up

• Ongoing monitoring every 6–12 months

Ongoing Monitoring Includes

• Corneal hypoxia

• Conjunctival prolapse

• Corneal edema

• Midday fogging

Regular follow-up is essential to maintain ocular health and ensure optimal long-term outcomes.

Insertion, Removal, and Lens Care

Successful scleral lens wear depends on proper patient education and compliance:

• Lenses are filled with preservative-free sterile saline before insertion

• Application using a plunger or tripod technique

• Daily cleaning and disinfection required

• Emphasis on hygiene and consistent care routines

Referral and Co-Management at Knight Vision Northwest

Scleral contact lenses are often recommended for patients who have not responded to conventional treatment options. Knight Vision Northwest works closely with:

• Corneal specialists

• Dry eye clinics

• Post-surgical care providers

In many cases, scleral lenses may qualify for insurance coverage under medically necessary contact lens codes.

Learn More or Refer a Patient

Knight Vision Northwest offers:

• Comprehensive scleral lens consultations

• Diagnostic fitting and advanced customization

• An evidence-based approach to complex ocular conditions

To learn more about scleral contact lenses or to refer a patient, please contact Knight Vision Northwest to schedule a consultation.